Provider Information for 1487226742
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QUENCINA GARDNER MS, LAPC
Sex: Female
NPI: 1487226742
Last Updated: 2021-07-15
Certification Date: 2021-07-14
Certification Date: 2021-07-14
Details
Name | Value | ||||||||||||||
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NPI | 1487226742 | ||||||||||||||
Enumeration Date | 2021-07-15 | ||||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||||
Sole Proprietor | NO | ||||||||||||||
Status | Active | ||||||||||||||
Mailing Address | 20 HERRELL RD VILLA RICA, GA 30180-5527 United States Phone: 770-812-3327 | Fax: | ||||||||||||||
Primary Practice Address | 20 HERRELL RD VILLA RICA, GA 30180-5527 United States Phone: 770-812-3327 | Fax: | ||||||||||||||
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