Provider Demographics
NPI:1487343893
Name:DUPHARE, PRAMILA KABRA
Entity type:Individual
Prefix:
First Name:PRAMILA
Middle Name:KABRA
Last Name:DUPHARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1476 CAMERON GLEN DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-3055
Mailing Address - Country:US
Mailing Address - Phone:770-309-1200
Mailing Address - Fax:
Practice Address - Street 1:1476 CAMERON GLEN DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-3055
Practice Address - Country:US
Practice Address - Phone:770-309-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002523133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered