Most Relevant Information
Provider Data
| NPI Number: | 1003521022 |
| Provider Name: | QUANIQUA CARLIE COO |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 01/16/2023 |
| Last Updated: | 11/20/2023 |
Provider Practice Location
2610 MILLEDGEVILLE RD
AUGUSTA
GA
309045110
Practice Location Phone/Fax
| Phone: | 8043006723 |
| Fax: |
Provider Mailing Location
750 FORDHAM RD
GROVETOWN
GA
308130400
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |