Individual
DR. SHIVANE K GUPTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4150 FIVE FORKS TRICKUM RD SW STE 1, LILBURN, GA 30047-3130
(770) 717-7225
(770) 717-7228
Mailing address
4150 FIVE FORKS TRICKUM RD SW STE 1, LILBURN, GA 30047-3130
(770) 717-7225
(770) 717-7228
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
078309
GA
Other
Enumeration date
06/24/2010
Last updated
07/06/2022
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