Individual
SANDHYA GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
755 WALTHER RD, LAWRENCEVILLE, GA 30046-8725
(678) 272-3699
(770) 290-8084
Mailing address
755 WALTHER RD, LAWRENCEVILLE, GA 30046-8725
(678) 272-3699
(770) 290-8084
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
9409
GA
363A00000X
Physician Assistant
Primary
9409
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1160403
NCCPA
GA
01
—
9409
GEORGIA MEDICAL COMPOSITE BOARD
GA
Enumeration date
08/14/2019
Last updated
03/12/2021
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