Provider Demographics
NPI:1992955736
Name:BANSAL, PURNIMA (MD)
Entity type:Individual
Prefix:DR
First Name:PURNIMA
Middle Name:
Last Name:BANSAL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 PEACHTREE INDUSTRIAL BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8627
Mailing Address - Country:US
Mailing Address - Phone:404-490-0754
Mailing Address - Fax:678-712-4389
Practice Address - Street 1:2730 PEACHTREE INDUSTRIAL BLVD STE 105
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-8627
Practice Address - Country:US
Practice Address - Phone:404-490-0754
Practice Address - Fax:678-712-4389
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47473207Q00000X
OH57.014325207Q00000X
MA247157207Q00000X
GA77084207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK182770Medicare PIN