Provider Demographics
NPI:1124426606
Name:IN CHARGE MEDICAL PROFESSIONALS LLC
Entity type:Organization
Organization Name:IN CHARGE MEDICAL PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMRAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:QURAISHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-345-1561
Mailing Address - Street 1:21 EASTBROOK BND STE 218
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1546
Mailing Address - Country:US
Mailing Address - Phone:678-967-5599
Mailing Address - Fax:866-594-0037
Practice Address - Street 1:21 EASTBROOK BND STE 218
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1546
Practice Address - Country:US
Practice Address - Phone:678-967-5599
Practice Address - Fax:866-594-0037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-15
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty