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General NPI Number Information
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NPI Number | 1881960383
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Entity Type | Organization
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Legal Business Name | MANMOHAN GUPTA M.D., P.C.
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Dates
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Enumeration Date | 03/29/2012
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Last Update Date | 03/29/2012
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Provider Practice Location Address
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Address Line | 770 PINE ST. SUITE 440
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City | MACON
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State | GA
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Zip | 31201-7599
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Country | US
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Telephone | 478-741-4588
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Fax | 478-741-4589
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Provider Business Mailing Address
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Address Line | P.O. BOX 13026
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City | MACON
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State | GA
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Zip | 31208-3026
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Country | US
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Telephone | 478-741-4588
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Fax | 478-741-4589
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Authorized Official
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Title or Position | OWNER
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Name | MANMOHAN GUPTA
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Credential | M.D.
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Telephone | 478-741-4588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 023976
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License Number State | GA
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