Provider Demographics
NPI:1063677011
Name:KHAN, KHURRAM A (MD)
Entity Type:Individual
Prefix:DR
First Name:KHURRAM
Middle Name:A
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:954 WOODWARD PARK DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2859
Mailing Address - Country:US
Mailing Address - Phone:678-665-5370
Mailing Address - Fax:
Practice Address - Street 1:500 SPRINGHOUSE CIR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-6741
Practice Address - Country:US
Practice Address - Phone:770-879-4330
Practice Address - Fax:678-684-3066
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067490207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine