Provider Demographics
NPI:1770555070
Name:KHATAMI, MOJGAN (MD)
Entity type:Individual
Prefix:DR
First Name:MOJGAN
Middle Name:
Last Name:KHATAMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1690 STONE VILLAGE LANE, NW
Mailing Address - Street 2:SUITE401
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152
Mailing Address - Country:US
Mailing Address - Phone:770-427-2533
Mailing Address - Fax:770-944-0327
Practice Address - Street 1:1690 STONE VILLAGE LN NW
Practice Address - Street 2:SUITE401
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7776
Practice Address - Country:US
Practice Address - Phone:770-427-2533
Practice Address - Fax:770-427-2534
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA42626207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology