Provider Demographics
NPI:1629428537
Name:KHALID, AMMARA (MD)
Entity Type:Individual
Prefix:
First Name:AMMARA
Middle Name:
Last Name:KHALID
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 1:226 E COLLEGE ST STE B
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4348
Mailing Address - Country:US
Mailing Address - Phone:678-987-1490
Mailing Address - Fax:678-987-1491
Practice Address - Street 1:226 E COLLEGE ST STE B
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4348
Practice Address - Country:US
Practice Address - Phone:678-987-1490
Practice Address - Fax:678-987-1491
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT211607207R00000X
GA90348207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine