Healthcare Provider Details

I. General information

NPI: 1629277017
Provider Name (Legal Business Name): ATLANTA CARDIOLOGY PRIMARY CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3562 HABERSHAM AT NORTHLAKE BUILDING J
TUCKER GA
30084-4009
US

IV. Provider business mailing address

3562 HABERSHAM AT NORTHLAKE BUILDING J
TUCKER GA
30084-4009
US

V. Phone/Fax

Practice location:
  • Phone: 404-296-1130
  • Fax: 404-296-1132
Mailing address:
  • Phone: 404-296-1130
  • Fax: 404-296-1132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number047506
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number037251
License Number StateGA

VIII. Authorized Official

Name: DR. BOBBY V KHAN
Title or Position: OWNER
Credential: M.D.
Phone: 404-296-1130