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NPI Code Detail

MEDICARE: DR. ISHTIAQ A. KHAN MD

MEDICARE: DR. ISHTIAQ A. 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
1174400000XSpecialist024280GA

General Provider Information

NPI Number : 1679618037
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ISHTIAQ A. KHAN MD
Provider Business Mailing Address
First Line : 791 OAK ST
Second Line :
City : HAPEVILLE
State : GA
Zip : 30354-1748
Country : US
Telephone Number : 404-601-2000
Fax Number : 404-559-0257
Provider Business Practice Location Address
First Line : 791 OAK ST
Second Line :
City : HAPEVILLE
State : GA
Zip : 30354-1748
Country : US
Telephone Number : 404-601-2000
Fax Number : 404-559-0257
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2007
Last Update Date : 07/08/2007

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Directions to “ DR. ISHTIAQ A. KHAN MD” Practice Location

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