MEDICARE: DR. AOUS S AL-KHALDI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	4021903	NC
2	2085R0202X	Diagnostic Radiology Physician	01814	WV
3	2085R0202X	Diagnostic Radiology Physician	054057	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P01064760	OTHER	GA	RAILROAD MEDICARE
5	P00466058	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	52388731 003	OTHER	GA	BCBSGA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	1072273	OTHER	WV	WORKERS COMPENSATION
7	52388731 002	OTHER	GA	BCBSGA
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548222094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AOUS S AL-KHALDI MD

Provider Business Mailing Address
First Line	:	106 JADE SPRING CT.
Second Line	:
City	:	MOORESVILLE
State	:	NC
Zip	:	28117
Country	:	US
Telephone Number	:	704-987-1498
Fax Number	:	304-598-2293

Provider Business Practice Location Address
First Line	:	1601 WATSON BLVD
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31093-3431
Country	:	US
Telephone Number	:	478-333-3603
Fax Number	:	478-333-3685

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	09/11/2012

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Directions to “ DR. AOUS S AL-KHALDI MD” Practice Location

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