Provider Demographics
NPI:1902196488
Name:MITRA, KUNAL (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:KUNAL
Middle Name:
Last Name:MITRA
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 WINDY HILL RD SE STE 200
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-2065
Mailing Address - Country:US
Mailing Address - Phone:770-941-7709
Mailing Address - Fax:770-941-6441
Practice Address - Street 1:1060 WINDY HILL RD SE STE 200
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-2065
Practice Address - Country:US
Practice Address - Phone:770-941-7709
Practice Address - Fax:770-941-6441
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-01371208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics