Provider Demographics
NPI:1306853916
Name:KHACHI, GERALD J (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:J
Last Name:KHACHI
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 1:1467 HARPER ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2600
Mailing Address - Country:US
Mailing Address - Phone:706-721-4628
Mailing Address - Fax:
Practice Address - Street 1:1467 HARPER ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2600
Practice Address - Country:US
Practice Address - Phone:706-721-4628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD429289208200000X
GAGA 059253208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery