Healthcare Provider Details

I. General information

NPI: 1306853916
Provider Name (Legal Business Name): GERALD J KHACHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 12/13/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1467 HARPER ST
AUGUSTA GA
30901-2600
US

IV. Provider business mailing address

1467 HARPER ST
AUGUSTA GA
30901-2600
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-4628
  • Fax:
Mailing address:
  • Phone: 706-721-4628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD429289
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberGA 059253
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: