Provider Demographics
NPI:1669621215
Name:KHAN, MUHAMMAD ALI NIAZ (MBBS)
Entity type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:ALI NIAZ
Last Name:KHAN
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8375 ELAN DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-4211
Mailing Address - Country:US
Mailing Address - Phone:203-430-1184
Mailing Address - Fax:
Practice Address - Street 1:915 GORDON AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6614
Practice Address - Country:US
Practice Address - Phone:229-228-8575
Practice Address - Fax:229-551-8776
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME120196207R00000X
GA063080207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine