Healthcare Provider Details

I. General information

NPI: 1063677011
Provider Name (Legal Business Name): KHURRAM A KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SPRINGHOUSE CIR
STONE MOUNTAIN GA
30087-6741
US

IV. Provider business mailing address

954 WOODWARD PARK DR
SUWANEE GA
30024-2859
US

V. Phone/Fax

Practice location:
  • Phone: 770-879-4330
  • Fax: 678-684-3066
Mailing address:
  • Phone: 678-665-5370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number067490
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number067490
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: