Provider Demographics
NPI:1891829883
Name:KAHN, HENRY SLATER (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:SLATER
Last Name:KAHN
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 1:947 BLUE RIDGE AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-4416
Mailing Address - Country:US
Mailing Address - Phone:770-488-1052
Mailing Address - Fax:770-488-1148
Practice Address - Street 1:30 WARREN ST SE
Practice Address - Street 2:DEKALB GRADY NEIGHBORHOOD HEALTH CENTER
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-2267
Practice Address - Country:US
Practice Address - Phone:404-616-9304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015110207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD40310Medicare UPIN