Healthcare Provider Details

I. General information

NPI: 1679736938
Provider Name (Legal Business Name): AHMAD KHALDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 WHITCHER STREET SUITE 3110
MARIETTA GA
30060
US

IV. Provider business mailing address

61 WHITCHER ST NE STE 3110
MARIETTA GA
30060-1179
US

V. Phone/Fax

Practice location:
  • Phone: 770-422-2326
  • Fax: 770-422-7797
Mailing address:
  • Phone: 770-422-2326
  • Fax: 770-422-7797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number125046943
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number0101249516
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberFK1937359
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberD0072280
License Number StateMD
# 5
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number68224
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD039565
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: