Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 067490 | GA |
NPI | 1063677011 |
---|---|
Provider Name | Dr. Khurram A Khan |
First Address | Suwanee, GA 30024-2859 |
Second Address | Stone Mountain, GA 30087-6741 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2008 |
Last Update Date | 15/10/2018 |