Active NPI
Kunal Mitra, MD, MBA
- Pediatrics Physician
- Smyrna, GA
National Provider Identifier
1902196488
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 2014-01371
- Practice address
- 1060 Windy Hill Rd SE Ste 200
Smyrna, GA 30080-2065 - Phone
- (770) 941-7709
- Fax
- (770) 941-6441
- NPI assigned
- Apr 18, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 2014-01371 | NC | Primary |
Addresses
Primary practice location
1060 Windy Hill Rd SE Ste 200
Smyrna, GA 30080-2065
Mailing address
1060 Windy Hill Rd SE Ste 200
Smyrna, GA 30080-2065
Phone (770) 941-7709
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Business Administration, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2014-01371 | NC | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cobb Pediatric Associates, PC | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatrics Physician
- Smyrna, GA
- NPI 1750434551
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1303084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531785600000",
"number": "1902196488",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1060 WINDY HILL RD SE STE 200",
"city": "SMYRNA",
"state": "GA",
"postal_code": "300802065",
"telephone_number": "770-941-7709",
"fax_number": "770-941-6441"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1060 WINDY HILL RD SE STE 200",
"city": "SMYRNA",
"state": "GA",
"postal_code": "300802065",
"telephone_number": "770-941-7709",
"fax_number": "770-941-6441"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITRA",
"first_name": "KUNAL",
"name_prefix": "Dr.",
"credential": "MD, MBA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-04-18",
"last_updated": "2018-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NC",
"license": "2014-01371",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Smyrna, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.