Provider Demographics
NPI:1609186360
Name:KHAN, SHEEMA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEEMA
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 1:699 CHURCH ST NE
Mailing Address - Street 2:STE 220
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1116
Mailing Address - Country:US
Mailing Address - Phone:770-422-8505
Mailing Address - Fax:770-424-7449
Practice Address - Street 1:699 CHURCH ST NE
Practice Address - Street 2:STE 220
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1116
Practice Address - Country:US
Practice Address - Phone:770-422-8505
Practice Address - Fax:770-424-7449
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA72350207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003149603AMedicaid