=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982670105
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NAJMA KHAN M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 MEDICAL CENTER BLVD
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30045-7694
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-442-3317
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 938 WOOD DUCK CT
-----------------------------------------------------
City | SNELLVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30078-7728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-523-2160
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207PH0002X
-----------------------------------------------------
Taxonomy Name | Hospice and Palliative Medicine (Emergency Medicine) Physician
-----------------------------------------------------
License Number | 059259
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------