Provider Demographics
NPI:1154818235
Name:BRAR, GURLEEN KAUR (DPM)
Entity Type:Individual
Prefix:
First Name:GURLEEN
Middle Name:KAUR
Last Name:BRAR
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:GURLEEN
Other - Middle Name:KAUR
Other - Last Name:CHEEMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:4101 CHARLOTTE AVE STE F185
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-4066
Mailing Address - Country:US
Mailing Address - Phone:678-426-2171
Mailing Address - Fax:
Practice Address - Street 1:5700 HILLANDALE DR STE 220
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-4103
Practice Address - Country:US
Practice Address - Phone:404-288-4117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-15
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001500213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1154818235Medicaid