Provider Demographics
NPI:1912088337
Name:KAPURIA, SANJEEV (MD)
Entity Type:Individual
Prefix:
First Name:SANJEEV
Middle Name:
Last Name:KAPURIA
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 1:404 TOWN PARK BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3471
Mailing Address - Country:US
Mailing Address - Phone:706-922-7246
Mailing Address - Fax:706-922-7247
Practice Address - Street 1:404 TOWN PARK BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3471
Practice Address - Country:US
Practice Address - Phone:706-922-7246
Practice Address - Fax:706-922-7247
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057090207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA339463OtherWELLCARE CMO
GA198493OtherBCBS
SCG57090Medicaid
GAP00320036OtherRRMEDICARE
GA107336457AMedicaid
GA107336457BMedicaid
GA550789920OtherTRICARE
I24390Medicare UPIN
GA107336457BMedicaid