Healthcare Provider Details

I. General information

NPI: 1558897124
Provider Name (Legal Business Name): REKHA KUMARI GUPTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 TULLIE RD NE
ATLANTA GA
30329-2309
US

IV. Provider business mailing address

737 BARNETT ST NE APT B1
ATLANTA GA
30306-4111
US

V. Phone/Fax

Practice location:
  • Phone: 270-348-3763
  • Fax:
Mailing address:
  • Phone: 270-348-3763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number92651
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: