Provider Demographics
NPI:1215469358
Name:QC FAMILY PRACTICE
Entity type:Organization
Organization Name:QC FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:QUINTON
Authorized Official - Middle Name:W
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:423-384-0614
Mailing Address - Street 1:508 PRINCETON RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2060
Mailing Address - Country:US
Mailing Address - Phone:423-384-0614
Mailing Address - Fax:
Practice Address - Street 1:508 PRINCETON RD
Practice Address - Street 2:SUITE 104
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2060
Practice Address - Country:US
Practice Address - Phone:423-384-0614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14954261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care