Provider Demographics
NPI:1477431377
Name:QSM ENTERPRISE CO.
Entity type:Organization
Organization Name:QSM ENTERPRISE CO.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MASTERS COSMETOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:QUENYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-229-6770
Mailing Address - Street 1:4323 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-1115
Mailing Address - Country:US
Mailing Address - Phone:910-229-6770
Mailing Address - Fax:
Practice Address - Street 1:4046 JIMMIE DYESS PKWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-9468
Practice Address - Country:US
Practice Address - Phone:706-840-0634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QSM ENTERPRISE CO.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-08-26
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier