MEDICARE: QCPI-VILLAGEMD, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	79130	GA
2	225100000X	Physical Therapist	79130	GA
3	207Q00000X	Family Medicine Physician	79130	GA

General Provider Information

NPI Number	:	1558872432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QCPI-VILLAGEMD, PC

Provider Business Mailing Address
First Line	:	3445 PEACHTREE RD NE STE 1200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-3251
Country	:	US
Telephone Number	:	773-831-9573
Fax Number	:	470-387-1639

Provider Business Practice Location Address
First Line	:	3445 PEACHTREE RD NE STE 1200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-3251
Country	:	US
Telephone Number	:	770-822-6853
Fax Number	:	470-387-1639

Authorized Official
Title or Position	:	DIRECTOR REVENUE CYCLE
Name	:	REBECCA RAGER
Credential	:
Telephone Number	:	844-969-0686

Provider Enumeration Date	:	10/18/2017
Last Update Date	:	03/25/2026

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