Healthcare Provider Details

I. General information

NPI: 1184289167
Provider Name (Legal Business Name): PARUL DUTTA MD FACP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2959 SHARPSBURG MCCULLUM RD
NEWNAN GA
30265-2297
US

IV. Provider business mailing address

2959 SHARPSBURG MCCULLUM RD
NEWNAN GA
30265-2297
US

V. Phone/Fax

Practice location:
  • Phone: 917-808-3968
  • Fax:
Mailing address:
  • Phone: 917-808-3968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number92914
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: