Provider Demographics
NPI:1356557409
Name:JOSEPH KHOURI MD, PC
Entity type:Organization
Organization Name:JOSEPH KHOURI MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-438-1002
Mailing Address - Street 1:3969 S COBB DR SE
Mailing Address - Street 2:STE 110
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6358
Mailing Address - Country:US
Mailing Address - Phone:770-438-1002
Mailing Address - Fax:770-438-7223
Practice Address - Street 1:3969 S COBB DR SE
Practice Address - Street 2:STE 110
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6358
Practice Address - Country:US
Practice Address - Phone:770-438-1002
Practice Address - Fax:770-438-7223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA24698173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD40350Medicare UPIN