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Individual

TARSEM L GUPTA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
245 VILLAGE CENTER PKWY STE 100, STOCKBRIDGE, GA 30281-9096
(770) 506-7171
(770) 506-8406
Mailing address
245 VILLAGE CENTER PKWY STE 100, STOCKBRIDGE, GA 30281-9096
(770) 506-7171
(770) 506-8406

Taxonomy

Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
028410
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000401178D
GA
05
000401178E
GA
05
300028737A
GA
01
592806
BCBS OF GEORGIA
GA
Enumeration date
08/24/2005
Last updated
09/30/2019
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