Provider Demographics
NPI:1194149021
Name:QUANTUM MEDICAL RADIOLOGY OF CALIFORNIA, PC
Entity type:Organization
Organization Name:QUANTUM MEDICAL RADIOLOGY OF CALIFORNIA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EUGUEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRETORIUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-625-3526
Mailing Address - Street 1:1200 B GALE WILSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3552
Mailing Address - Country:US
Mailing Address - Phone:707-646-5000
Mailing Address - Fax:
Practice Address - Street 1:3520 PIEDMONT RD NE
Practice Address - Street 2:SUITE 250
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1516
Practice Address - Country:US
Practice Address - Phone:404-870-2802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty