Healthcare Provider Details

I. General information

NPI: 1922441393
Provider Name (Legal Business Name): ANJULI MOHAN GUPTA D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5354 REYNOLDS ST STE 202
SAVANNAH GA
31405-6009
US

IV. Provider business mailing address

5354 REYNOLDS ST STE 202
SAVANNAH GA
31405-6009
US

V. Phone/Fax

Practice location:
  • Phone: 912-352-0920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOT015155
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number91879
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: