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General NPI Number Information
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NPI Number | 1972841963
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Entity Type | Organization
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Legal Business Name | MOHAMMAD A. KHAN, M.D. LLC
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Dates
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Enumeration Date | 01/25/2013
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Last Update Date | 01/25/2013
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Provider Practice Location Address
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Address Line | 754 CHEROKEE ST NE SUITE A
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City | MARIETTA
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State | GA
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Zip | 30060-8955
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Country | US
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Telephone | 770-428-8118
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Fax | 770-428-8854
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Provider Business Mailing Address
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Address Line | 754 CHEROKEE ST NE SUITE A
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City | MARIETTA
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State | GA
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Zip | 30060-8955
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Country | US
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Telephone | 770-428-8118
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Fax | 770-428-8854
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Authorized Official
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Title or Position | M.D.
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Name | DR. MOHAMMAD A KHAN
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Credential | M.D.
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Telephone | 770-428-8118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 042314
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License Number State | GA
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