Organization
MANMOHAN GUPTA M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MANMOHAN GUPTA M.D. (OWNER)
(478) 741-4588
Entity
Organization
Contact information
Practice address
770 PINE ST., SUITE 440, MACON, GA 31201-7599
(478) 741-4588
(478) 741-4589
Mailing address
P.O. BOX 13026, MACON, GA 31208-3026
(478) 741-4588
(478) 741-4589
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
023976
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00249796-A
—
GA
Enumeration date
03/29/2012
Last updated
03/29/2012
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