Provider Demographics
NPI:1982602074
Name:CHARKAWI, AHMAD (MD)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:
Last Name:CHARKAWI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ZACK
Other - Middle Name:
Other - Last Name:CHARKAWI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD FACGS
Mailing Address - Street 1:6300 HOSPITAL PARKWAY, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097
Mailing Address - Country:US
Mailing Address - Phone:770-771-6591
Mailing Address - Fax:770-771-6599
Practice Address - Street 1:6300 HOSPITAL PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097
Practice Address - Country:US
Practice Address - Phone:770-771-6591
Practice Address - Fax:770-771-6599
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38121207Q00000X
GA061566207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000300578OtherANTHEM
KY64074909Medicaid
KYK38121OtherCHOICE CARE
KYC398426Medicare UPIN
KYH94284Medicare UPIN
KY64074909Medicaid
KYK38121OtherCHOICE CARE