Healthcare Provider Details

I. General information

NPI: 1427030212
Provider Name (Legal Business Name): ATUL MOHAN GUPTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 01/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55A SHERIDAN PARK CIR
BLUFFTON SC
29910-6025
US

IV. Provider business mailing address

1694 OLD TOWNE ROAD
CHARLESTON SC
29407-5045
US

V. Phone/Fax

Practice location:
  • Phone: 843-836-5111
  • Fax: 843-836-5112
Mailing address:
  • Phone: 843-571-3100
  • Fax: 843-766-7798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number23765
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number23765
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: