# OMAR QUEENSBOURROW

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659625911
- **Authorized official:** OMAR QUEENSBOURROW PA (PHYSICIAN ASSISTANT)
- **Authorized official phone:** (800) 507-8874

## Contact information

- **Practice address:** 305 HOSPITAL DRIVE, MACON, GA 31217
- **Practice address phone:** (478) 746-4646
- **Mailing address:** 305 HOSPITAL DRIVE, APT 106, MACON, GA 31217
- **Mailing address phone:** (478) 746-4646

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282N00000X | General Acute Care Hospital | PA9106708 | FL | Yes |

## Other

- **Enumeration date:** 11/07/2012
- **Last updated:** 11/19/2012