Healthcare Provider Details

I. General information

NPI: 1821252081
Provider Name (Legal Business Name): GHAZANFAR HUSEIN QURESHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1468 MONTREAL RD
TUCKER GA
30084-6901
US

IV. Provider business mailing address

1468 MONTREAL RD # 320
TUCKER GA
30084-6901
US

V. Phone/Fax

Practice location:
  • Phone: 470-273-6263
  • Fax: 678-916-4957
Mailing address:
  • Phone: 470-273-6263
  • Fax: 678-916-4957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number253253-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0066145
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number32594
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number81220
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberTMP-01972
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: