Provider Demographics
NPI:1376581231
Name:KHAN, PANYAVEE (MD)
Entity Type:Individual
Prefix:
First Name:PANYAVEE
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 1:4310 JOHNS CREEK PKWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6091
Mailing Address - Country:US
Mailing Address - Phone:770-476-4020
Mailing Address - Fax:770-476-1674
Practice Address - Street 1:4310 JOHNS CREEK PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6091
Practice Address - Country:US
Practice Address - Phone:770-476-4020
Practice Address - Fax:770-476-1674
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054756208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics