Provider Demographics
NPI:1437116720
Name:KHAN, GHAZALI ATAULLAH (MD)
Entity Type:Individual
Prefix:DR
First Name:GHAZALI
Middle Name:ATAULLAH
Last Name:KHAN
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:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:ETOWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37331-0325
Mailing Address - Country:US
Mailing Address - Phone:423-263-2444
Mailing Address - Fax:423-263-1553
Practice Address - Street 1:301 GRADY ROAD
Practice Address - Street 2:
Practice Address - City:ETOWAH
Practice Address - State:TN
Practice Address - Zip Code:37331-0325
Practice Address - Country:US
Practice Address - Phone:423-263-2444
Practice Address - Fax:423-263-1553
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN025977207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3086308Medicaid
TN4031195OtherBCBS
F93986Medicare UPIN
TN4031195OtherBCBS