Provider Demographics
NPI:1639131691
Name:DUA, AMIT K (MD)
Entity Type:Individual
Prefix:
First Name:AMIT
Middle Name:K
Last Name:DUA
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 1:303 PIRKLE FERRY RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2544
Mailing Address - Country:US
Mailing Address - Phone:770-887-5553
Mailing Address - Fax:770-781-2375
Practice Address - Street 1:303 PIRKLE FERRY RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2544
Practice Address - Country:US
Practice Address - Phone:770-887-5553
Practice Address - Fax:770-781-2375
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050695207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000955094BMedicaid
H49102Medicare UPIN
GA000955094BMedicaid