Provider Demographics
NPI:1962495267
Name:AL-KHARRAT, TAMIM MOHAMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMIM
Middle Name:MOHAMAD
Last Name:AL-KHARRAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TAMIN
Other - Middle Name:
Other - Last Name:KHARRAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:219 RIVERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5256
Mailing Address - Country:US
Mailing Address - Phone:770-345-2670
Mailing Address - Fax:770-345-2671
Practice Address - Street 1:219 RIVERSTONE DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5256
Practice Address - Country:US
Practice Address - Phone:770-345-2670
Practice Address - Fax:770-345-2671
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045382174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA045382OtherSTATE LICENSE NUMBER
GA045382OtherSTATE LICENSE NUMBER