Healthcare Provider Details

I. General information

NPI: 1710381926
Provider Name (Legal Business Name): FARZEEN AHMED KHURRAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6325 HOSPITAL PKWY
JOHNS CREEK GA
30097-5775
US

IV. Provider business mailing address

PO BOX 102632
ATLANTA GA
30368-2632
US

V. Phone/Fax

Practice location:
  • Phone: 678-474-7038
  • Fax:
Mailing address:
  • Phone: 404-386-7816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberL.3942R
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number76625
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: