Provider Demographics
NPI:1164526323
Name:KHAN, SHAZIA (MD)
Entity Type:Individual
Prefix:
First Name:SHAZIA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 HIGHWAY 34 E
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1323
Mailing Address - Country:US
Mailing Address - Phone:770-304-3724
Mailing Address - Fax:770-304-3726
Practice Address - Street 1:1425 HIGHWAY 34 E
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1323
Practice Address - Country:US
Practice Address - Phone:770-304-3724
Practice Address - Fax:770-304-3726
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048905207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4757OtherMEDICARE GROUP NUMBER
GA39BDCFQOtherCARRIER PROVIDER NUMBER
GAGRP4757OtherMEDICARE GROUP NUMBER