Purnima Bansal, M.D.
Individual provider Active NPI Family Medicine Physician · Duluth, GA
NPI 1992955736 · NPPES record last updated Apr 23, 2025
Key facts
- NPI
- 1992955736
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 77084 (GA)
- Practice address
- 2730 Peachtree Industrial Blvd Ste 105
Duluth, GA 30097-8627 - Phone
- (404) 490-0754
- Fax
- (678) 712-4389
- NPI assigned
- Sep 29, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170615001286 | GA | Practitioner - Family Practice | 1850541962 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 77084 | GA | MD | Family Medicine Physician |
| 47473 | KY | MD | Family Medicine Physician |
| 247157 | MA | MD | Family Medicine Physician |
| 57.014325 | OH | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northside Hospital, Inc. | Current |
Accepting new patients | |
| Gwinnett Pathology Assoc PC | Current | Accepting new patients | |
| Northside Hospital, Inc. | Current | Accepting new patients | |
| The Southeast Permanente Medical Group | Family Medicine | Current |
Accepting new patients |
| Peachtree Immediate Care FP, LLC | Family Medicine | Current |
Accepting new patients |
Locations
3495 Piedmont Rd NE
Bldg 9
Atlanta, GA 30305
Phone (404) 364-7000
3551 Satellite Blvd
Duluth, GA 30096
Phone (770) 476-3000
3650 Steve Reynolds Blvd
Duluth, GA 30096
Phone (770) 931-6010
590 Lanier Ave W
Fayetteville, GA 30214
1275 Highway 54 W
Ste 201
Fayetteville, GA 30214
Phone (770) 461-3776
3827 Jimmy Lee Smith Pkwy
Hiram, GA 30141
Phone (770) 222-8900
665 Duluth Hwy
Ste 501
Lawrenceville, GA 30046
Phone (678) 312-0400
1000 Medical Center Blvd
Lawrenceville, GA 30046
Phone (678) 312-3356
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 47473 | KY | |
| Family Medicine Physician | 207Q00000X | 57.014325 | OH | |
| Family Medicine Physician | 207Q00000X | 247157 | MA | |
| Family Medicine Physician | 207Q00000X | 77084 | GA | Yes |
Addresses
Primary practice location
2730 Peachtree Industrial Blvd Ste 105
Duluth, GA 30097-8627
Mailing address
2730 Peachtree Industrial Blvd Ste 105
Duluth, GA 30097-8627
Phone (404) 490-0754
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq | Health Information Exchange (HIE) | Permanente Medical Group |
Other providers in Duluth, GA
- Michael Romani Bakheet
- Balance Advanced Dentistry & Orthodontics Gwinnett LLC
- Duianice Monique Baldwin
- Allen William Ballar
- Janna Myesha Banks
- Erjia Bao
- Margaret Barnard
- Sara Barr
- Kimberley Yatzary Barrera
- Madhuri P Basavaraju
All providers in Duluth, GA · Family Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 23, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.