Provider Demographics
NPI:1578849444
Name:AL-MOOSAWI, KHALDOON J (MD)
Entity Type:Individual
Prefix:
First Name:KHALDOON
Middle Name:J
Last Name:AL-MOOSAWI
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 1:4245 JOHNS CREEK PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-9122
Mailing Address - Country:US
Mailing Address - Phone:678-990-3962
Mailing Address - Fax:678-840-3777
Practice Address - Street 1:4245 JOHNS CREEK PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-9122
Practice Address - Country:US
Practice Address - Phone:678-990-3962
Practice Address - Fax:678-840-3777
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005364207Q00000X
NC2015-00835207QS1201X, 390200000X
GA69749207QS1201X
GA069749207Q00000X, 207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program