Provider Demographics
NPI:1093884355
Name:KHALID, AIJAZ A (MD)
Entity Type:Individual
Prefix:DR
First Name:AIJAZ
Middle Name:A
Last Name:KHALID
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 1:170 CAMDEN HILL RD STE A
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-7418
Mailing Address - Country:US
Mailing Address - Phone:678-990-8015
Mailing Address - Fax:678-990-8019
Practice Address - Street 1:170 CAMDEN HILL RD STE A
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-7418
Practice Address - Country:US
Practice Address - Phone:678-990-8015
Practice Address - Fax:678-990-8019
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA382712084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology