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General NPI Number Information
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NPI Number | 1063677011
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Entity Type | Individual
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Provider Name | KHURRAM A KHAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/18/2008
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 500 SPRINGHOUSE CIR
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-6741
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Country | US
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Telephone | 770-879-4330
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Fax | 678-684-3066
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Provider Business Mailing Address
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Address Line | 954 WOODWARD PARK DR
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City | SUWANEE
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State | GA
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Zip | 30024-2859
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Country | US
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Telephone | 678-665-5370
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 067490
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 067490
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License Number State | GA
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