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Individual

DR. ASHWINI K. GUPTA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
405 ARROWHEAD BLVD, JONESBORO, GA 30236-1254
(770) 478-9877
(770) 478-2908
Mailing address
236 MONTROSE DR, MCDONOUGH, GA 30253-4242
(770) 389-9852

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
025981
GA
208VP0000X
Pain Medicine Physician
025981
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00307744E
GA
01
050030319
RAILROAD MEDICARE
GA
Enumeration date
11/01/2005
Last updated
12/11/2007
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