Individual
VIVEK V. GURUDUTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1360 UPPER HEMBREE RD, SUITE 201B, ROSWELL, GA 30076-1171
(770) 475-3361
(770) 664-4431
Mailing address
4150 DEPUTY BILL CANTRELL MEMORIAL DR SUITE 260, CUMMING, GA 30040-2721
(770) 292-3045
(770) 292-3046
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
73912
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
246039YEXC
MEDICARE PTAN
PA
Enumeration date
07/21/2006
Last updated
04/06/2021
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