Provider Demographics
NPI:1184889792
Name:KHAN, AHAD MASROOR (MD)
Entity type:Individual
Prefix:
First Name:AHAD
Middle Name:MASROOR
Last Name:KHAN
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 1:367 ATHENS HWY 78
Mailing Address - Street 2:BLDG 100
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-2204
Mailing Address - Country:US
Mailing Address - Phone:678-466-6760
Mailing Address - Fax:678-802-7094
Practice Address - Street 1:367 ATHENS HWY 78
Practice Address - Street 2:BLDG 100
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-2204
Practice Address - Country:US
Practice Address - Phone:678-466-6760
Practice Address - Fax:678-802-7094
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055763208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery