Individual
JOSE QUEZADA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1325 SATELLITE BLVD NW STE 400, SUWANEE, GA 30024-5299
(263) 678-2633
Mailing address
1325 SATELLITE BLVD NW STE 400, SUWANEE, GA 30024-5299
(263) 678-2633
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
RN292069
GA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN292069
GA
Other
Enumeration date
02/29/2024
Last updated
05/22/2024
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