Individual
DR. KRISHAN KUMAR GUPTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1059 RIDGEWOOD PL, JACKSON, MS 39211-2018
(601) 957-3211
(601) 957-9753
Mailing address
PO BOX 13531, JACKSON, MS 39236-3531
(601) 957-3211
(601) 957-9753
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
12941
MS
2084P0800X
Psychiatry Physician
Primary
12941
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014822
—
MS
Enumeration date
06/10/2005
Last updated
03/25/2021
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