Individual
DR. NITIN GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
980 JOHNSON FY RD NE STE 820, ATLANTA, GA 30342-1608
(404) 252-9307
(404) 252-5839
Mailing address
1001 SUMMIT BLVD STE B, BROOKHAVEN, GA 30319-6408
(770) 989-1668
(678) 388-1759
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
22586
MS
207RG0100X
Gastroenterology Physician
Primary
078939
GA
207RG0100X
Gastroenterology Physician
22586
MS
207RG0100X
Gastroenterology Physician
249386
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003203822A
—
GA
05
—
02959257
—
MS
01
—
P01402449
RR MEDICARE
MS
Enumeration date
06/25/2007
Last updated
10/03/2018
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