Individual
DR. MICHAEL IAN QUACKENBUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1285 HEMBREE RD, SUITE 200A, ROSWELL, GA 30076-5720
(770) 475-2710
(770) 360-0498
Mailing address
4500 HOSPITAL BLVD STE 230, ROSWELL, GA 30076-0001
(770) 956-4560
(770) 475-8968
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
072421
GA
207XX0801X
Orthopaedic Trauma Physician
25MB08109900
NJ
207XX0801X
Orthopaedic Trauma Physician
34009678
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003149994A
—
GA
05
—
2987237
—
OH
Enumeration date
06/15/2007
Last updated
10/27/2021
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