Healthcare Provider Details

I. General information

NPI: 1124540281
Provider Name (Legal Business Name): AMIT PUJARI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 COLLIER RD NW STE 2045
ATLANTA GA
30309-1723
US

IV. Provider business mailing address

95 COLLIER RD NW STE 2045
ATLANTA GA
30309-1723
US

V. Phone/Fax

Practice location:
  • Phone: 505-605-5110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number114088
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2086H0002X
TaxonomyHospice and Palliative Medicine (Surgery) Physician
License Number114088
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: