Provider Demographics
NPI:1912141094
Name:KHERA, KRISHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISHAN
Middle Name:
Last Name:KHERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3623 J DEWEY GRAY CIR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6511
Mailing Address - Country:US
Mailing Address - Phone:706-922-6052
Mailing Address - Fax:855-229-2493
Practice Address - Street 1:3623 J DEWEY GRAY CIR
Practice Address - Street 2:SUITE 210
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6511
Practice Address - Country:US
Practice Address - Phone:706-922-6052
Practice Address - Fax:855-229-2493
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.121513208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program