Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 8632 | NC |
N | 213EG0000X | General Practice | 8632 | NC |
N | 1223P0221X | Pediatric Dentist | 8632 | NC |
Y | 1223P0221X | Pediatric Dentist | DN015122 | GA |
NPI | 1033371091 |
---|---|
Provider Name | Priya Gulati |
First Address | Suwanee, GA 30024-6914 |
Second Address | Suwanee, GA 30024-6914 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2008 |
Last Update Date | 22/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1978 | (05) | NC |