MEDICARE: DR. PURNIMA BANSAL 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	207Q00000X	Family Medicine Physician	47473	KY
2	207Q00000X	Family Medicine Physician	57.014325	OH
3	207Q00000X	Family Medicine Physician	247157	MA
4	207Q00000X	Family Medicine Physician	77084	GA

General Provider Information

NPI Number	:	1992955736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PURNIMA BANSAL M.D.

Provider Business Mailing Address
First Line	:	2730 PEACHTREE INDUSTRIAL BLVD STE 105
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30097-8627
Country	:	US
Telephone Number	:	404-490-0754
Fax Number	:	678-712-4389

Provider Business Practice Location Address
First Line	:	2730 PEACHTREE INDUSTRIAL BLVD STE 105
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30097-8627
Country	:	US
Telephone Number	:	404-490-0754
Fax Number	:	678-712-4389

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

Provider Enumeration Date	:	09/29/2008
Last Update Date	:	04/23/2025

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