Quresh Z Bandukwala, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

A39105 Issued in CA

Practice address

314 Shorter Ave NW
Suite100
Rome, GA 30165-4268

Phone

(706) 235-5722

Fax

(706) 235-5728

NPI assigned

Jan 18, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jason Edward Watts, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Woodstock, GA
  • NPI 1083171326

  GA

  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1124170097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 SHORTER AVE NW",
            "address_2": "SUITE100",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301654268",
            "telephone_number": "706-235-5722",
            "fax_number": "706-235-5728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 SHORTER AVE NW",
            "address_2": "SUITE100",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301654268",
            "telephone_number": "706-235-5722",
            "fax_number": "706-235-5728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANDUKWALA",
        "first_name": "QURESH",
        "middle_name": "Z",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-18",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "GA",
            "license": "027959",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A39105",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "GA",
            "license": "027959",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00340458A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sharon Delores Baker, BSN MN CWHNP
• Balanced Living Counseling Center
• Michael Ball, RPH.
• Rebeka Lynn Ball, FNP-C
• Harsha Vardhan Reddy Banavasi, MD
• Abby Bannister, BCBA
• John Scott Baranchok, PHD
• Jarrad Alexander Barber, MD
• Jennifer Davis Barbieri, MD
• Garrett H Barnes, M.D.

• All providers in Rome, GA
• Psychiatry Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.