Individual
DR. VIVEK KUMAR GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6002 PROFESSIONAL PARKWAY, SUITE 100, DOUGLASVILLE, GA 30134
(770) 949-4200
(770) 949-5553
Mailing address
6002 PROFESSIONAL PARKWAY, SUITE 100, DOUGLASVILLE, GA 30134
(770) 949-4200
(770) 949-5553
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
052734
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003379537A
—
GA
05
—
003379537B
—
GA
01
—
072044
BLUE
—
01
—
323384
WELLCARE
—
01
—
5418507001
CIGNA
—
01
—
7157520
AETNA PPO
—
01
—
P00107542
RAILROAD MEDICARE
—
Enumeration date
07/17/2006
Last updated
07/14/2011
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