Provider Demographics
NPI:1558872432
Name:QCPI-VILLAGEMD, PC
Entity Type:Organization
Organization Name:QCPI-VILLAGEMD, PC
Other - Org Name:VILLAGE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:I
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-513-4897
Mailing Address - Street 1:3445 PEACHTREE RD NE STE 1200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-3251
Mailing Address - Country:US
Mailing Address - Phone:770-822-6853
Mailing Address - Fax:470-387-1639
Practice Address - Street 1:3445 PEACHTREE RD NE STE 1200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-3251
Practice Address - Country:US
Practice Address - Phone:770-822-6853
Practice Address - Fax:470-387-1639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA79130207Q00000X, 207R00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty