Bandukwala, Quresh Z
Bandukwala, Quresh Z is an sole proprietor health care provider with primary practice located at 314 Shorter Ave Nw Suite100, Rome GA 30165-4268. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Psychiatry, Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry. Allopathic & Osteopathic Physicians / Psychiatry is his primary health care specialty. Bandukwala, Quresh Z can be contacted via phone (706) 235-5722.Contact Information
Primary practice address
314 Shorter Ave Nw Suite100
Rome GA 30165-4268
Phone: (706) 235-5722
Fax: (706) 235-5728
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | 027959 | Georgia |
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | A39105 | California |
| Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry | 2084P0804X | 027959 | Georgia |
Profile Details
| NPI number | 1124170097 |
|---|---|
| LBN Legal business name | Bandukwala, Quresh Z |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 18th, 2007 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1124170097 | NPPES |
| Georgia | MEDICAID | 00340458A |
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