Healthcare Provider Details

I. General information

NPI: 1366672867
Provider Name (Legal Business Name): KIRSHMA KHEMANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 06/06/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 CLIFTON RD NE
ATLANTA GA
30322-1060
US

IV. Provider business mailing address

1405 CLIFTON RD NE
ATLANTA GA
30322-1060
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-1112
  • Fax: 404-785-6288
Mailing address:
  • Phone: 404-785-1112
  • Fax: 404-785-6288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number74736
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: