Healthcare Provider Details

I. General information

NPI: 1912118324
Provider Name (Legal Business Name): NAMITA KHANNA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NAMITA JHAMB MD

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 A CLIFTON RD, BUILDING AA, 4'TH FLOOR
ATLANTA GA
30332-2200
US

IV. Provider business mailing address

1365 A CLIFTON RD, BUILDING AA, 4'TH FLOOR
ATLANTA GA
30332-2200
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-4416
  • Fax:
Mailing address:
  • Phone: 404-778-4416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberME92608
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number064847
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: