Healthcare Provider Details

I. General information

NPI: 1821500042
Provider Name (Legal Business Name): QCPI-VILLAGEMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2017
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
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

1 N FRANKLIN STREET SUITE 1205
CHICAGO IL
60606
US

V. Phone/Fax

Practice location:
  • Phone: 678-553-4603
  • Fax: 470-387-1639
Mailing address:
  • Phone: 847-264-5585
  • Fax:

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 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