Provider Demographics
NPI:1609843036
Name:GULATI, BRIJ B (MD)
Entity Type:Individual
Prefix:
First Name:BRIJ
Middle Name:B
Last Name:GULATI
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:5475 HUNTINGTON MIST DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3339
Mailing Address - Country:US
Mailing Address - Phone:404-784-6279
Mailing Address - Fax:770-879-6801
Practice Address - Street 1:130 EAGLE SPRING CT
Practice Address - Street 2:STE#100A
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7274
Practice Address - Country:US
Practice Address - Phone:678-284-0133
Practice Address - Fax:678-284-6393
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA525702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI60697Medicare UPIN
GA26BDKMFMedicare ID - Type Unspecified