Provider Demographics
NPI:1932183811
Name:QADRI, MUNTZRA KHATOON (MD)
Entity Type:Individual
Prefix:DR
First Name:MUNTZRA
Middle Name:KHATOON
Last Name:QADRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 ATHENS HWY STE 1800
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-8293
Mailing Address - Country:US
Mailing Address - Phone:770-554-2999
Mailing Address - Fax:770-679-6390
Practice Address - Street 1:1026 TWELVE OAKS PL STE A
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-4917
Practice Address - Country:US
Practice Address - Phone:706-521-0999
Practice Address - Fax:770-679-6390
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047916Q2084P0800X
GA668882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0564830Medicaid
OHQA0552674Medicare ID - Type Unspecified
OHA81333Medicare UPIN