Healthcare Provider Details

I. General information

NPI: 1144301862
Provider Name (Legal Business Name): US ARMY MEDDAC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7950 MARTIN LOOP MARTIN ARMY COMM HOSPTAL FT.BENNING
COLUMBUS GA
31905
US

IV. Provider business mailing address

7950 MARTIN LOOP MARTIN ARMY COMM HOSPTAL FT.BENNING
COLUMBUS GA
31905
US

V. Phone/Fax

Practice location:
  • Phone: 706-544-1946
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number StateGA

VIII. Authorized Official

Name: ZEHERA N.A KHAN
Title or Position: PHYSICIAN
Credential: MD
Phone: 706-544-1946