Healthcare Provider Details

I. General information

NPI: 1558872432
Provider Name (Legal Business Name): QCPI-VILLAGEMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 PEACHTREE RD NE STE 1200
ATLANTA GA
30326-3251
US

IV. Provider business mailing address

3445 PEACHTREE RD NE STE 1200
ATLANTA GA
30326-3251
US

V. Phone/Fax

Practice location:
  • Phone: 770-822-6853
  • Fax: 470-387-1639
Mailing address:
  • Phone: 773-831-9573
  • Fax: 470-387-1639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number79130
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number79130
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number79130
License Number StateGA

VIII. Authorized Official

Name: REBECCA RAGER
Title or Position: DIRECTOR REVENUE CYCLE
Credential:
Phone: 844-969-0686