Healthcare Provider Details

I. General information

NPI: 1104828250
Provider Name (Legal Business Name): WASIL KHAN MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 EISENHOWER DR BLDG 2
SAVANNAH GA
31406-3928
US

IV. Provider business mailing address

1326 EISENHOWER DR BLDG 2
SAVANNAH GA
31406-3928
US

V. Phone/Fax

Practice location:
  • Phone: 912-527-5335
  • Fax: 912-527-5336
Mailing address:
  • Phone: 912-527-5335
  • Fax: 912-527-5336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number056116
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number27796
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: