Healthcare Provider Details

I. General information

NPI: 1700226172
Provider Name (Legal Business Name): NIRUPAMA TAMIRISA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 NORTHWINDS PKWY
ALPHARETTA GA
30009-2232
US

IV. Provider business mailing address

1025 E 32ND ST
AUSTIN TX
78705-2714
US

V. Phone/Fax

Practice location:
  • Phone: 800-930-0748
  • Fax:
Mailing address:
  • Phone: 512-544-5253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2013025717
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR8495
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberR8495
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number13629-320
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: