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General NPI Number Information
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NPI Number | 1992877344
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Entity Type | Individual
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Provider Name | AYESHA KHAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 333 MIDWAY RD NW
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City | MARIETTA
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State | GA
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Zip | 30064-5630
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Country | US
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Telephone | 984-283-1722
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Fax | 888-498-3729
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Provider Business Mailing Address
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Address Line | 1587 PETAL PT NW
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City | KENNESAW
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State | GA
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Zip | 30152-7773
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Country | US
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Telephone |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2016-00151
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 058338
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 058338
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License Number State | GA
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