MEDICARE: SARA ARIADNE KHAN RDN

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	133V00000X	Registered Dietitian	LD006866	GA

General Provider Information

NPI Number	:	1720843188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA ARIADNE KHAN RDN

Provider Business Mailing Address
First Line	:	3650 ASHFORD DUNWOODY RD NE UNIT 1023
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30319-2065
Country	:	US
Telephone Number	:	404-421-0064
Fax Number	:

Provider Business Practice Location Address
First Line	:	3650 ASHFORD DUNWOODY RD NE UNIT 1023
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30319-2065
Country	:	US
Telephone Number	:	404-421-0064
Fax Number	:

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

Provider Enumeration Date	:	02/15/2024
Last Update Date	:	02/15/2024

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