DataLabs

datalabs.health made in the usa

Contact us Sign in | Documentation |

divider

Medicare/Medicaid Verification Programs divider

divider

Medicare Verification Program divider

divider

1003820291

NPI Code Detail

MEDICARE: DR. FAZAL M KHAN MD

MEDICARE: DR. FAZAL M KHAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083A0300X	Addiction Medicine (Preventive Medicine) Physician	76623	GA
2	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician	MD-2008-0223	NM
3	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician	76623	GA
4	2084P0301X	Brain Injury Medicine (Psychiatry & Neurology) Physician	76623	GA
5	2084P0800X	Psychiatry Physician	MD-2008-0223	NM
6	2084P0805X	Geriatric Psychiatry Physician	76623	GA
7	2084P0800X	Psychiatry Physician	76623	GA

General Provider Information

NPI Number	:	1003820291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FAZAL M KHAN MD

Provider Business Mailing Address
First Line	:	PO BOX 742616
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-2616
Country	:	US
Telephone Number	:	770-219-8420
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 WISTERIA DR
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-3827
Country	:	US
Telephone Number	:	770-219-5407
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	11/08/2021

Similar Medicare Providers

1033573266 — ANNA MERCADO SANCHEZ CNP
Practice Location Address:

200 WISTERIA DR
GAINESVILLE, GA
30501-3827

Practice Phone: 770-219-5407
Practice Fax: 770-219-7102

1770566341 — SHAHZAD M HASHMI M.D.,
Practice Location Address:

200 WISTERIA DR
GAINESVILLE, GA
30501-3827

Practice Phone: 770-219-5407
Practice Fax:

1376562488 — MRS. AMELIA SIKA MATHEW MD
Practice Location Address:

200 WISTERIA DR
GAINESVILLE, GA
30501-3827

Practice Phone: 770-219-5407
Practice Fax: 770-219-7102

1346371622 — DR. KALPANA R PRASAD MD
Practice Location Address:

200 WISTERIA DR
GAINESVILLE, GA
30501-3827

Practice Phone: 770-219-5407
Practice Fax:

1962610634 — PARUL DEV MD
Practice Location Address:

200 WISTERIA DR
GAINESVILLE, GA
30501-3827

Practice Phone: 770-219-5407
Practice Fax:

1326245366 — ELISABETH BARCLAY MD
Practice Location Address:

200 WISTERIA DR
GAINESVILLE, GA
30501-3827

Practice Phone: 770-219-5407
Practice Fax: 770-219-7102

Directions to “ DR. FAZAL M KHAN MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.