Provider Demographics
NPI:1619405933
Name:GUPTA, KUNAL (MD)
Entity Type:Individual
Prefix:
First Name:KUNAL
Middle Name:
Last Name:GUPTA
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 1:210 COBB PKWY S STE 100
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-6509
Mailing Address - Country:US
Mailing Address - Phone:678-695-9577
Mailing Address - Fax:770-427-9154
Practice Address - Street 1:210 COBB PKWY S STE 100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-6509
Practice Address - Country:US
Practice Address - Phone:678-695-9577
Practice Address - Fax:770-427-9154
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA85075207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine