Provider Demographics
NPI:1861495830
Name:NASS, KHALED (MD)
Entity Type:Individual
Prefix:
First Name:KHALED
Middle Name:
Last Name:NASS
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:PO BOX 740209
Mailing Address - Street 2:DEPARTMENT 40233
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0209
Mailing Address - Country:US
Mailing Address - Phone:678-450-0202
Mailing Address - Fax:678-450-0080
Practice Address - Street 1:663 LANIER PARK DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2059
Practice Address - Country:US
Practice Address - Phone:678-450-0202
Practice Address - Fax:678-450-0080
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2019-01-17
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
GA43717207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00839198Medicaid
GA202I398938Medicare PIN
H00694Medicare UPIN