Provider Demographics
NPI:1760433304
Name:AL SAADI, KHALDON A (MD)
Entity Type:Individual
Prefix:DR
First Name:KHALDON
Middle Name:A
Last Name:AL SAADI
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 1:204 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:GA
Mailing Address - Zip Code:31510-2908
Mailing Address - Country:US
Mailing Address - Phone:912-632-0314
Mailing Address - Fax:912-632-2554
Practice Address - Street 1:204 E 15TH ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:GA
Practice Address - Zip Code:31510-2908
Practice Address - Country:US
Practice Address - Phone:912-632-0314
Practice Address - Fax:912-632-2554
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA53974208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010173800002Medicaid
PA403266Medicare ID - Type Unspecified
PA0010173800002Medicaid