Provider Demographics
NPI:1821189408
Name:KHALIL, HITHAM H (MD)
Entity Type:Individual
Prefix:
First Name:HITHAM
Middle Name:H
Last Name:KHALIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2109 N PATTERSON ST STE B
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2577
Mailing Address - Country:US
Mailing Address - Phone:229-469-7271
Mailing Address - Fax:844-662-3122
Practice Address - Street 1:2109 N PATTERSON ST STE B
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2577
Practice Address - Country:US
Practice Address - Phone:229-469-7271
Practice Address - Fax:844-662-3122
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA058261207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA319783970AMedicaid
I64314Medicare UPIN
GA319783970AMedicaid