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General NPI Number Information
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NPI Number | 1285772020
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Entity Type | Individual
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Provider Name | SIMA LAL GUPTA O.D., M.P.H.
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Gender | Female
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 12/27/2011
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Provider Practice Location Address
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Address Line | 860 PEACHTREE ST NE SUITE F
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City | ATLANTA
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State | GA
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Zip | 30308-1249
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Country | US
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Telephone | 404-853-5008
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Fax |
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Provider Business Mailing Address
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Address Line | 860 PEACHTREE ST NE SUITE F
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City | ATLANTA
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State | GA
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Zip | 30308-1249
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Country | US
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Telephone | 404-853-5008
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV007026
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT002472
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License Number State | GA
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