Provider Demographics
NPI:1710149455
Name:KHURRAM, SAIMA (MD)
Entity Type:Individual
Prefix:DR
First Name:SAIMA
Middle Name:
Last Name:KHURRAM
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 1:145 RIVERSTONE TER
Mailing Address - Street 2:STE 102
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5317
Mailing Address - Country:US
Mailing Address - Phone:767-886-6363
Mailing Address - Fax:855-255-5736
Practice Address - Street 1:145 RIVERSTONE TER
Practice Address - Street 2:STE 102
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5317
Practice Address - Country:US
Practice Address - Phone:767-886-6363
Practice Address - Fax:855-255-5736
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0694702084N0400X
GA0031202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003133133EMedicaid
GA003133133GMedicaid
GA003133133HMedicaid
GA003133133HMedicaid