Provider Demographics
NPI:1801601513
Name:CULLINS, QUINTEN JR
Entity type:Individual
Prefix:MR
First Name:QUINTEN
Middle Name:
Last Name:CULLINS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 ATLANTA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-2192
Mailing Address - Country:US
Mailing Address - Phone:470-483-4811
Mailing Address - Fax:678-782-3373
Practice Address - Street 1:97 ATLANTA ST STE 100
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-2192
Practice Address - Country:US
Practice Address - Phone:470-483-4811
Practice Address - Fax:678-782-3373
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver