Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 59652 | GA |
N | 111NI0900X | Internist | 59652 | GA |
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 059652 | GA |
N | 207RC0000X | Internist - Cardiovascular Disease | 059652 | GA |
NPI | 1962606392 |
---|---|
Provider Name | Dr. Divya Gupta |
First Address | Atlanta, GA 30307-2142 |
Second Address | Atlanta, GA 30332-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2007 |
Last Update Date | 22/08/2017 |