Healthcare Provider Details

I. General information

NPI: 1083174502
Provider Name (Legal Business Name): SHAMA KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 COLLIER RD NW STE 2000
ATLANTA GA
30309-1734
US

IV. Provider business mailing address

105 COLLIER RD NW STE 2000
ATLANTA GA
30309-1734
US

V. Phone/Fax

Practice location:
  • Phone: 404-350-1122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-14524
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberE-14524
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME155077
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number110491
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: