Organization
QUALIFIED QUACKS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADRIENNE BOTOS CLARK BSN, RN (FOUNDER)
(770) 750-5099
Entity
Organization
Contact information
Practice address
1545 RAINIER FALLS DR NE, ATLANTA, GA 30329-4105
(404) 719-6746
Mailing address
1545 RAINIER FALLS DR NE, ATLANTA, GA 30329-4105
(404) 719-6746
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
Other
Enumeration date
10/18/2021
Last updated
10/18/2021
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