Healthcare Provider Details

I. General information

NPI: 1801113204
Provider Name (Legal Business Name): MARIAM QURESHI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 BUFORD HWY NE STE 275
BROOKHAVEN GA
30329-2143
US

IV. Provider business mailing address

2801 BUFORD HWY NE STE 275
BROOKHAVEN GA
30329-2143
US

V. Phone/Fax

Practice location:
  • Phone: 404-490-1785
  • Fax:
Mailing address:
  • Phone: 404-882-7700
  • Fax: 470-275-0744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number80901
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036136610
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01081783A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: