Healthcare Provider Details

I. General information

NPI: 1003810623
Provider Name (Legal Business Name): RUPAL PATEL GUPTA DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RUPAL NARENDRA PATEL DPM

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4355 JOHNS CREEK PKWY SUITE 520
SUWANEE GA
30024-6048
US

IV. Provider business mailing address

3995 MONTGLENN TRCE
CUMMING GA
30041-7373
US

V. Phone/Fax

Practice location:
  • Phone: 770-418-0456
  • Fax: 770-418-1603
Mailing address:
  • Phone: 770-418-0456
  • Fax: 770-418-1603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD000958
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: