Healthcare Provider Details

I. General information

NPI: 1245989441
Provider Name (Legal Business Name): ABDUL AZIZ KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 ALLEN MEMORIAL DR STE 201
BREMEN GA
30110-2062
US

IV. Provider business mailing address

204 ALLEN MEMORIAL DR STE 201
BREMEN GA
30110-2062
US

V. Phone/Fax

Practice location:
  • Phone: 770-537-6500
  • Fax: 770-824-2600
Mailing address:
  • Phone: 770-537-6500
  • Fax: 770-824-2600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number105267
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: