Individual
PORSCHE' QUINCOLA THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MEDICAL WIG PROVIDER
Contact information
Practice address
3535 PEACHTREE RD NE STE 527, ATLANTA, GA 30326-3287
(734) 686-7523
(404) 671-8588
Mailing address
3535 PEACHTREE RD NE, P.O.BOX 527, ATLANTA, GA 30326
(734) 686-7523
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
—
GA
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
GA
Other
Enumeration date
01/02/2023
Last updated
09/11/2023
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