Provider Demographics
NPI:1811966831
Name:GUPTA, SUNITA (MD)
Entity type:Individual
Prefix:DR
First Name:SUNITA
Middle Name:
Last Name:GUPTA
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 1:370 PROSPECT PL
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-5467
Mailing Address - Country:US
Mailing Address - Phone:678-393-3374
Mailing Address - Fax:678-393-9374
Practice Address - Street 1:370 PROSPECT PL
Practice Address - Street 2:GEORGETOWN OFFICE PARK
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-5467
Practice Address - Country:US
Practice Address - Phone:678-393-3374
Practice Address - Fax:678-393-9374
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0494542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA584723830ABMedicaid
GA584723830AMedicaid
7586528OtherAETNA
7586528OtherAETNA
26BDKFQMedicare ID - Type Unspecified