Provider Demographics
NPI:1326038142
Name:KHAIR, SAM A (MD)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:A
Last Name:KHAIR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:125 EAGLE SPRING DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6328
Mailing Address - Country:US
Mailing Address - Phone:770-213-3366
Mailing Address - Fax:404-962-6943
Practice Address - Street 1:125 EAGLE SPRING DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6328
Practice Address - Country:US
Practice Address - Phone:770-213-3366
Practice Address - Fax:404-962-6943
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2014-02-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA35194207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA7927OtherKAISER
GA0102000OtherUNITED HEALTHCARE
GA314129OtherWELLCARE
GA000486241FMedicaid
GA080039316OtherRAILROAD MEDICARE
GA52027054001OtherBC/BS GEORGIA
GA10033142OtherAMERIGROUP
GA1071040001OtherPEACHSTATE
GA0102000OtherUNITED HEALTHCARE
GA314129OtherWELLCARE