Provider Demographics
NPI:1295736940
Name:KHIM, ANTHONY D (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:D
Last Name:KHIM
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 BERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-6409
Mailing Address - Country:US
Mailing Address - Phone:615-599-1647
Mailing Address - Fax:
Practice Address - Street 1:101 BERRYWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-6409
Practice Address - Country:US
Practice Address - Phone:931-381-2110
Practice Address - Fax:931-381-5178
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA94865208800000X
TN867084174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3041871OtherBLUE CROSS BLUE SHIELD TN
TN3803653Medicare ID - Type Unspecified
TN340013057Medicare PIN
TN3041871OtherBLUE CROSS BLUE SHIELD TN