Provider Demographics
NPI:1790729085
Name:EDUPUGANTI, HIMA B (MD)
Entity Type:Individual
Prefix:DR
First Name:HIMA
Middle Name:B
Last Name:EDUPUGANTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2850 PACES FERRY RD SE
Mailing Address - Street 2:SUITE 460
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5719
Mailing Address - Country:US
Mailing Address - Phone:678-556-4950
Mailing Address - Fax:678-556-4951
Practice Address - Street 1:2850 PACES FERRY RD SE
Practice Address - Street 2:SUITE 460
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5719
Practice Address - Country:US
Practice Address - Phone:678-556-4950
Practice Address - Fax:678-556-4951
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA64027207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003100359AMedicaid
GA003100359AMedicaid
GA202I110878Medicare PIN