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General NPI Number Information
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NPI Number | 1194884247
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Entity Type | Organization
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Legal Business Name | TARSEM L. GUPTA, MD, PC
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 04/30/2008
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Provider Practice Location Address
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Address Line | 830 EAGLES LANDING PKWY SUITE 101
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7384
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Country | US
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Telephone | 770-506-7171
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Fax | 770-506-8406
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Provider Business Mailing Address
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Address Line | 830 EAGLES LANDING PKWY SUITE 101
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7384
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Country | US
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Telephone | 770-506-7171
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Fax | 770-506-8406
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KIRAN GUPTA
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Credential |
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Telephone | 770-506-7171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 028410
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License Number State | GA
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