Provider Demographics
NPI:1417150632
Name:GULATI, SUJOY (MD)
Entity Type:Individual
Prefix:
First Name:SUJOY
Middle Name:
Last Name:GULATI
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 1:9175 TUCKERBROOK LN
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-6170
Mailing Address - Country:US
Mailing Address - Phone:678-427-0997
Mailing Address - Fax:
Practice Address - Street 1:9175 TUCKERBROOK LN
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-6170
Practice Address - Country:US
Practice Address - Phone:678-427-0997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061873A207P00000X
GA62043207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CA762OtherBCBSTX THRU SAEMA
TX201847502Medicaid
GAGRP4155OtherMEDICARE GROUP NUMBER
IN200884020Medicaid
TX201847501Medicaid
GA409444037AMedicaid
TXP00744177OtherRAILROAD THRU AEMA
IN200884020Medicaid
TXP00744177OtherRAILROAD THRU AEMA
TX201847501Medicaid
TX8L8981Medicare PIN
INM400057955Medicare Oscar/Certification