Provider Demographics
NPI:1346262599
Name:DIABETES AND HYPERTENSION CENTER
Entity Type:Organization
Organization Name:DIABETES AND HYPERTENSION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NARENDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-495-0011
Mailing Address - Street 1:10160 MEDLOCK BRIDGE ROAD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4419
Mailing Address - Country:US
Mailing Address - Phone:770-495-0011
Mailing Address - Fax:770-495-0012
Practice Address - Street 1:10160 MEDLOCK BRIDGE RD
Practice Address - Street 2:SUITE #100
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4419
Practice Address - Country:US
Practice Address - Phone:770-495-0011
Practice Address - Fax:770-495-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA260Q00000X261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6899Medicare ID - Type Unspecified