1598292310 NPI number — SUPERIOR QUALITY GROUP, INC

Table of content: (NPI 1598292310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598292310 NPI number — SUPERIOR QUALITY GROUP, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUPERIOR QUALITY GROUP, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598292310
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10719 ALPHARETTA HWY
Provider Second Line Business Mailing Address:
SUITE 324
Provider Business Mailing Address City Name:
ROSWELL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30077-5657
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-647-1150
Provider Business Mailing Address Fax Number:
888-261-6640

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10719 ALPHARETTA HWY
Provider Second Line Business Practice Location Address:
SUITE 324
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30077-5657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-647-1150
Provider Business Practice Location Address Fax Number:
888-261-6640
Provider Enumeration Date:
05/11/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
YOUNGER
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
678-256-4574

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)