Provider Demographics
NPI:1740769538
Name:CHOWDHURY, KHADEJA (PA)
Entity type:Individual
Prefix:
First Name:KHADEJA
Middle Name:
Last Name:CHOWDHURY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5434 DURHAM VIEW CT NW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-5896
Mailing Address - Country:US
Mailing Address - Phone:678-335-6200
Mailing Address - Fax:
Practice Address - Street 1:4652 LAWRENCEVILLE HWY NW STE 104
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3623
Practice Address - Country:US
Practice Address - Phone:678-437-1659
Practice Address - Fax:678-437-1340
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2025-01-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA9224363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant