Provider Demographics
NPI:1023540697
Name:UPPAL, MALVIKA (MD)
Entity Type:Individual
Prefix:
First Name:MALVIKA
Middle Name:
Last Name:UPPAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MALVIKA
Other - Middle Name:
Other - Last Name:KAPOOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:600 PROFESSIONAL DR STE 210
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-7650
Mailing Address - Country:US
Mailing Address - Phone:678-457-9615
Mailing Address - Fax:
Practice Address - Street 1:6300 HOSPITAL PKWY STE 250
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-2454
Practice Address - Country:US
Practice Address - Phone:770-495-6258
Practice Address - Fax:770-495-8219
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-01
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA85606208000000X, 207K00000X
LA325985208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program