Individual
CHARU GUPTA PRAKASH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
677 CHURCH ST NE # 111, MARIETTA, GA 30060-1101
(770) 793-7750
Mailing address
805 SANDY PLAINS ROAD, MEDICAL STAFF SERVICES, MARIETTA, GA 30066-6340
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
065300
GA
207R00000X
Internal Medicine Physician
MT188913
PA
208M00000X
Hospitalist Physician
Primary
065300
GA
Other
Enumeration date
08/25/2007
Last updated
10/31/2019
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