Provider Demographics
NPI:1073742029
Name:KHAN, FAHAD (MD)
Entity Type:Individual
Prefix:
First Name:FAHAD
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3580 CAMERON PKWY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7816
Mailing Address - Country:US
Mailing Address - Phone:770-996-6446
Mailing Address - Fax:770-996-6279
Practice Address - Street 1:3580 CAMERON PKWY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7816
Practice Address - Country:US
Practice Address - Phone:770-996-6446
Practice Address - Fax:770-996-6279
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA78057207R00000X, 207RN0300X
CAA121333208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist