Healthcare Provider Details

I. General information

NPI: 1689324527
Provider Name (Legal Business Name): FARAAD KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 REDMOND RD NW
ROME GA
30165-1415
US

IV. Provider business mailing address

1633 TAYLOR OAKS DR
LAWRENCEVILLE GA
30043-1530
US

V. Phone/Fax

Practice location:
  • Phone: 706-802-3025
  • Fax: 844-863-6774
Mailing address:
  • Phone: 678-552-3418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number105295
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: