MEDICARE: DR. NITIN GUPTA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	22586	MS
2	207RG0100X	Gastroenterology Physician	249386	MA
3	207RG0100X	Gastroenterology Physician	22586	MS
4	207RG0100X	Gastroenterology Physician	078939	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01402449	OTHER	MS	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013113364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NITIN GUPTA M.D.

Provider Business Mailing Address
First Line	:	1001 SUMMIT BLVD STE B
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30319-6408
Country	:	US
Telephone Number	:	770-989-1668
Fax Number	:	678-388-1759

Provider Business Practice Location Address
First Line	:	980 JOHNSON FY RD NE STE 820
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1608
Country	:	US
Telephone Number	:	404-252-9307
Fax Number	:	404-252-5839

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	10/03/2018

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Directions to “ DR. NITIN GUPTA M.D.” Practice Location

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