Provider Demographics
NPI:1255320479
Name:KHOURY, CHARLES K (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:K
Last Name:KHOURY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:145 N MEDICAL PKWY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-7031
Mailing Address - Country:US
Mailing Address - Phone:770-592-3000
Mailing Address - Fax:770-592-3012
Practice Address - Street 1:145 N MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-7031
Practice Address - Country:US
Practice Address - Phone:770-592-3000
Practice Address - Fax:770-592-3012
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA029339207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine