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NPI Code Detail

MEDICARE: ROSHAN KHAKI, LLC

MEDICARE: ROSHAN KHAKI, LLC
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
1133V00000XRegistered DietitianLD002087GA

General Provider Information

NPI Number : 1205110244
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROSHAN KHAKI, LLC
Provider Business Mailing Address
First Line : 6851 ROSWELL ROAD
Second Line : UNIT # O-13
City : SANDY SPRINGS
State : GA
Zip : 30328-2456
Country : US
Telephone Number : 770-804-0138
Fax Number :
Provider Business Practice Location Address
First Line : 6851 ROSWELL RD NE
Second Line : UNIT # O-13
City : SANDY SPRINGS
State : GA
Zip : 30328-2456
Country : US
Telephone Number : 770-804-0138
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MRS. ROSHAN KHAKI
Credential : RD., LD., CDE
Telephone Number : 770-804-0138
Provider Enumeration Date : 10/10/2011
Last Update Date : 10/10/2011

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Directions to “ROSHAN KHAKI, LLC ” Practice Location

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