Basic Information
| Provider Information | |||||||||
| NPI: | 1649206962 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IMRAN | ||||||||
| FirstName: | YASMEEN | ||||||||
| MiddleName: | QUDDOOS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2701 N DECATUR RD | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300335918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4045015227 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2701 N DECATUR RD | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300335918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4045015227 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 09/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 064393 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0300X | 41100 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207RG0300X | 38635 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 282N00000X | 64393 | GA | N | Hospitals | General Acute Care Hospital | 208M00000X | 064393 | GA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 00890 | 01 | TN | BLUE ADVANTAGE | OTHER | TID | 01 | TN | BEECH STREET | OTHER | 6995651 | 01 | TN | CIGNA | OTHER | 9351066 | 01 | TN | PCHS | OTHER | 10067493 | 01 | TN | AMERIGROUP | OTHER | 4132017 | 01 | TN | BCBS | OTHER | P 00381130 | 01 | TN | RRMC | OTHER | TN 0101 | 01 | TN | AMERICHOICE | OTHER | 3825837 | 01 | TN | TENNCARE | OTHER | 108267 | 01 | TN | HEALTHSPRING | OTHER | 11312199 | 01 | TN | COVENTRY | OTHER | 3735141 | 05 | TN | MEDICAID | 7968666 | 01 | TN | AETNA | OTHER |