Provider Demographics
NPI:1457702466
Name:KHALID, SHAZA (MD)
Entity type:Individual
Prefix:
First Name:SHAZA
Middle Name:
Last Name:KHALID
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 W JAMES M CAMPBELL BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4674
Mailing Address - Country:US
Mailing Address - Phone:319-840-4455
Mailing Address - Fax:931-490-7027
Practice Address - Street 1:1224 TROTWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4802
Practice Address - Country:US
Practice Address - Phone:931-840-4455
Practice Address - Fax:931-490-7027
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT211751207R00000X
FLME149157207RI0200X
TN73317207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine