Provider Demographics
NPI:1861486557
Name:MAHMOOD, KHAWAJA R (MD)
Entity Type:Individual
Prefix:
First Name:KHAWAJA
Middle Name:R
Last Name:MAHMOOD
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:12 SAMMY MCGHEE BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-4093
Mailing Address - Country:US
Mailing Address - Phone:706-253-9898
Mailing Address - Fax:706-253-9896
Practice Address - Street 1:12 SAMMY MCGHEE BLVD
Practice Address - Street 2:STE 102
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4093
Practice Address - Country:US
Practice Address - Phone:706-253-9898
Practice Address - Fax:706-253-9896
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2012-02-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0426482080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000721718UMedicaid
GAG38749Medicare UPIN