Healthcare Provider Details

I. General information

NPI: 1003212044
Provider Name (Legal Business Name): ALVINA QURESHI O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2014
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 NORTHSIDE DR
MACON GA
31210-2418
US

IV. Provider business mailing address

329 CARILLON LN
MACON GA
31210-9711
US

V. Phone/Fax

Practice location:
  • Phone: 478-475-1600
  • Fax: 478-475-1600
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5220
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number03204
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: