Healthcare Provider Details

I. General information

NPI: 1093963365
Provider Name (Legal Business Name): MICHAEL NABIL KHOURY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 POPLAR RD STE 110
NEWNAN GA
30265-2817
US

IV. Provider business mailing address

1525 BUFORD HWY
BUFORD GA
30518-3665
US

V. Phone/Fax

Practice location:
  • Phone: 678-633-3500
  • Fax:
Mailing address:
  • Phone: 470-325-1300
  • Fax: 470-325-1301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number204243
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number75081
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: