Provider Demographics
NPI:1194156174
Name:QSS GEORGIA LLC
Entity type:Organization
Organization Name:QSS GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAREEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-894-1263
Mailing Address - Street 1:695 US HIGHWAY 46
Mailing Address - Street 2:SUITE 400A
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-1592
Mailing Address - Country:US
Mailing Address - Phone:973-826-8080
Mailing Address - Fax:855-834-5436
Practice Address - Street 1:3400 OLD MILTON PKWY
Practice Address - Street 2:BLDG C SUITE 330
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3707
Practice Address - Country:US
Practice Address - Phone:973-826-8080
Practice Address - Fax:855-834-5436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty