Healthcare Provider Details

I. General information

NPI: 1639131691
Provider Name (Legal Business Name): AMIT K DUA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 PIRKLE FERRY RD
CUMMING GA
30040-2544
US

IV. Provider business mailing address

303 PIRKLE FERRY RD
CUMMING GA
30040-2544
US

V. Phone/Fax

Practice location:
  • Phone: 770-887-5553
  • Fax: 770-781-2375
Mailing address:
  • Phone: 770-887-5553
  • Fax: 770-781-2375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number050695
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: