Healthcare Provider Details

I. General information

NPI: 1437375391
Provider Name (Legal Business Name): GAUTAM KUMAR MBBS, MRCP(UK)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE NEST
ATLANTA GA
30308
US

IV. Provider business mailing address

550 PEACHTREE NEST
ATLANTA GA
30308-2247
US

V. Phone/Fax

Practice location:
  • Phone: 404-686-4411
  • Fax:
Mailing address:
  • Phone: 404-686-2247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number64129
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number64129
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number64129
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: