Provider Demographics
NPI:1477749687
Name:KAPOOR, SMITA (MD)
Entity type:Individual
Prefix:
First Name:SMITA
Middle Name:
Last Name:KAPOOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:993 JOHNSON FY RD NE BLDG F
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1620
Mailing Address - Country:US
Mailing Address - Phone:404-256-1727
Mailing Address - Fax:404-256-0192
Practice Address - Street 1:2860 RONALD REAGAN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6289
Practice Address - Country:US
Practice Address - Phone:470-215-1920
Practice Address - Fax:404-252-3591
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37572207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ261969Medicaid