Provider Demographics
NPI:1760465108
Name:KAPOOR, HARSH (MD)
Entity Type:Individual
Prefix:
First Name:HARSH
Middle Name:
Last Name:KAPOOR
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 1:550 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 1620
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2209
Mailing Address - Country:US
Mailing Address - Phone:404-885-7701
Mailing Address - Fax:404-885-7777
Practice Address - Street 1:11685 ALPHARETTA HWY
Practice Address - Street 2:SUITE 305
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4913
Practice Address - Country:US
Practice Address - Phone:770-569-0777
Practice Address - Fax:770-569-7631
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA50812207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00936845AMedicaid
GA10BBCLKMedicare ID - Type Unspecified
GA00936845AMedicaid