Provider Demographics
NPI:1194884247
Name:TARSEM L. GUPTA, MD, PC
Entity type:Organization
Organization Name:TARSEM L. GUPTA, MD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-506-7171
Mailing Address - Street 1:830 EAGLES LANDING PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7384
Mailing Address - Country:US
Mailing Address - Phone:770-506-7171
Mailing Address - Fax:770-506-8406
Practice Address - Street 1:830 EAGLES LANDING PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7384
Practice Address - Country:US
Practice Address - Phone:770-506-7171
Practice Address - Fax:770-506-8406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028410207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA297160Medicaid
GA000401178EMedicaid
GA000401178DMedicaid
GA592806OtherBCBS OF GEORGIA
GA300028737AMedicaid
GA01000147Medicaid
GA=========OtherHUMANA GOLD
GA000401178EMedicaid
GA01000147Medicaid
GA=========OtherUNITED HEALTHCARE OF GA
GA=========OtherTRICARE
GA29BDCBDMedicare PIN
GA=========OtherAETNA
GA592806OtherBCBS OF GEORGIA