Provider Demographics
NPI:1124379037
Name:QADRI, ISHTYAQ YASIEN (MBBS, PA-C)
Entity Type:Individual
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First Name:ISHTYAQ
Middle Name:YASIEN
Last Name:QADRI
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Gender:M
Credentials:MBBS, PA-C
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Mailing Address - Street 1:11115 CROFTON OVERLOOK CT
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1950
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1670 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:404-728-5094
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2022-05-05
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Provider Licenses
StateLicense IDTaxonomies
NC0010-03776363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant