Provider Demographics
NPI:1922442755
Name:EL KHATIB, MOHAMAD MOUSTAPHA (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:MOUSTAPHA
Last Name:EL KHATIB
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 1:101 FITNESS WAY
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2480
Mailing Address - Country:US
Mailing Address - Phone:256-216-9730
Mailing Address - Fax:
Practice Address - Street 1:101 FITNESS WAY
Practice Address - Street 2:SUITE 2100
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2480
Practice Address - Country:US
Practice Address - Phone:256-216-9730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.34406282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural