Individual
DR. KRUNAL JETHWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
4800 OLDE TOWNE PKWY STE 150A, MARIETTA, GA 30068-4357
(770) 509-1025
(770) 509-1884
Mailing address
4800 OLDE TOWNE PKWY STE 150A, MARIETTA, GA 30068-4357
(770) 509-1025
(770) 509-1884
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
39401
SC
207Q00000X
Family Medicine Physician
Primary
87558
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
394013
—
SC
01
—
SC91675193
MEDICARE PIN
SC
01
—
SC91676067
MEDICARE PIN
SC
01
—
SC91676121
MEDICARE PIN
SC
01
—
SC9167J577
MEDICARE PIN
SC
Enumeration date
07/27/2012
Last updated
06/18/2021
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