Provider Demographics
NPI:1104866334
Name:DUA, ANUJ KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANUJ
Middle Name:KUMAR
Last Name:DUA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:684 SIXES RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30115-8721
Mailing Address - Country:US
Mailing Address - Phone:770-704-6101
Mailing Address - Fax:770-704-6316
Practice Address - Street 1:684 SIXES RD
Practice Address - Street 2:SUITE 225
Practice Address - City:HOLLY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30115-8721
Practice Address - Country:US
Practice Address - Phone:770-704-6101
Practice Address - Fax:770-704-6316
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA053856208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA594877089BMedicaid
GA02BDHVWMedicare ID - Type Unspecified
GAI28867Medicare UPIN