Provider Demographics
NPI:1972841963
Name:MOHAMMAD A. KHAN, M.D. LLC
Entity Type:Organization
Organization Name:MOHAMMAD A. KHAN, M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-428-8118
Mailing Address - Street 1:754 CHEROKEE ST NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8955
Mailing Address - Country:US
Mailing Address - Phone:770-428-8118
Mailing Address - Fax:770-428-8854
Practice Address - Street 1:754 CHEROKEE ST NE
Practice Address - Street 2:SUITE A
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8955
Practice Address - Country:US
Practice Address - Phone:770-428-8118
Practice Address - Fax:770-428-8854
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOHAMMAD A. KHAN, M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042314261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care