Provider Demographics
NPI:1164452272
Name:AHLUWALIA, GURPREET S (MD)
Entity Type:Individual
Prefix:DR
First Name:GURPREET
Middle Name:S
Last Name:AHLUWALIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 DELK RD
Mailing Address - Street 2:#700 PMB #304
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067
Mailing Address - Country:US
Mailing Address - Phone:770-715-2850
Mailing Address - Fax:
Practice Address - Street 1:840 KENNESAW AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060
Practice Address - Country:US
Practice Address - Phone:770-715-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040295101YM0800X, 2084P0800X
ALMD276782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00609738AMedicaid
AL330034002Medicaid
AL330234657Medicaid
AL330000002Medicaid
AL330200657Medicaid
GA00609738AMedicaid
GAF54330Medicare UPIN
GA2GBDKGFMedicare PIN