Provider Demographics
NPI:1124053384
Name:KHURANA, SUPREETI K (MD)
Entity type:Individual
Prefix:DR
First Name:SUPREETI
Middle Name:K
Last Name:KHURANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27690
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31221-7690
Mailing Address - Country:US
Mailing Address - Phone:478-746-1333
Mailing Address - Fax:478-746-0022
Practice Address - Street 1:770 PINE ST
Practice Address - Street 2:SIUTE 580
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2173
Practice Address - Country:US
Practice Address - Phone:478-746-1333
Practice Address - Fax:478-746-0022
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039143207V00000X, 207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000720409JMedicaid
GAG43643Medicare UPIN
GA16BDTTLMedicare ID - Type UnspecifiedMEDICARE PROVIDER #