Individual
OMAR S QUEENSBOURROW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
5185 OLD NATIONAL HWY, ATLANTA, GA 30349-3244
(404) 763-9300
(404) 763-9306
Mailing address
198 GREENVIEW TER, MACON, GA 31220-8755
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
006678
GA
363AM0700X
Medical Physician Assistant
PA 9106708
FL
Other
Enumeration date
11/19/2012
Last updated
08/04/2021
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