Healthcare Provider Details

I. General information

NPI: 1124426606
Provider Name (Legal Business Name): IN CHARGE MEDICAL PROFESSIONALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2014
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 EASTBROOK BND STE 218
PEACHTREE CITY GA
30269-1546
US

IV. Provider business mailing address

21 EASTBROOK BND STE 218
PEACHTREE CITY GA
30269-1546
US

V. Phone/Fax

Practice location:
  • Phone: 678-967-5599
  • Fax: 866-594-0037
Mailing address:
  • Phone: 678-967-5599
  • Fax: 866-594-0037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KAMRAN R QURAISHI
Title or Position: OWNER
Credential:
Phone: 502-345-1561