Provider Demographics
NPI:1821087644
Name:EL-KHASHAB, INGIE M (DPM)
Entity Type:Individual
Prefix:
First Name:INGIE
Middle Name:M
Last Name:EL-KHASHAB
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11180 STATE BRIDGE RD STE 501
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-7484
Mailing Address - Country:US
Mailing Address - Phone:404-373-7004
Mailing Address - Fax:404-373-7008
Practice Address - Street 1:11180 STATE BRIDGE RD STE 501
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-7484
Practice Address - Country:US
Practice Address - Phone:404-373-7004
Practice Address - Fax:404-373-7008
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000986213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV05923Medicare UPIN
GA6139410001Medicare NSC
GA511I480043Medicare PIN