Fazal M Khan, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

76623 Issued in GA

Practice address

200 Wisteria Dr
Gainesville, GA 30501-3827

Phone

(770) 219-5407

NPI assigned

Jul 27, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 7

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA, NC, IL3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 3

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• FL HMO D-SNP
• devoted network organization-25ba88d3-d0a6-4213-84f1-eef6f2b59f68
• devoted network organization-84bf27aa-506a-49c4-8818-702cf5e8efb3
• devoted network organization-d5084670-562f-408b-b100-22a1a4ef4d82
• devoted network organization-0f7f8d4f-1035-4992-8c02-dc86d12e700e
• FL HMO C-SNP
• devoted network organization-14bfd35d-d818-4696-813b-340339e464ef
• AL HMO
• AL HMO D-SNP
• FL HMO
• TN PPO C-SNP
• TN PPO

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Christopher Dennis MD PLLC

  • Psychiatry Physician
  • Johns Creek, GA
  • NPI 1588090229
  Medicare reassignment NPD
• Northeast Georgia Physicians Group Inc

  • Family Medicine Physician
  • Gainesville, GA
  • NPI 1891745212
  Medicare reassignment NPD
• Holly Hill Hospital LLC

  • Psychiatric Hospital
  • Raleigh, NC
  • NPI 1518037233

  Psychiatry

  Medicare reassignment NPD
• Illinois Department of Human Services

  • Intellectual Disabilities Intermediate Care Facility
  • Centralia, IL
  • NPI 1003960394
  Medicare reassignment NPD
• Illinois Department of Human Services

  • Psychiatric Hospital
  • Chester, IL
  • NPI 1306834726
  NPD
• Illinois Department of Human Services

  • Psychiatric Hospital
  • Hines, IL
  • NPI 1902903487
  NPD
• Horizon Mental Health Management LLC

  • Psychiatry Physician
  • Lewisville, TX
  • NPI 1255380176
  NPD (past)
• South Carolina Dept of Mental Health Accounting Office

  • Community/Behavioral Health Agency
  • Columbia, SC
  • NPI 1083421994
  NPD (past)
• Southeastern Regional Mental Health Center

  • Counselor
  • Lumberton, NC
  • NPI 1689809782
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636329600000",
    "number": "1003820291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 742616",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303742616",
            "telephone_number": "770-219-8420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 WISTERIA DR",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013827",
            "telephone_number": "770-219-5407"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "794 Watermark Dr",
            "address_purpose": "LOCATION",
            "city": "Evans",
            "state": "GA",
            "postal_code": "308097486",
            "country_code": "US",
            "telephone_number": "706-432-6312",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHAN",
        "first_name": "FAZAL",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2021-11-08",
        "certification_date": "2021-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083A0300X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": "GA",
            "license": "76623",
            "primary": false
        },
        {
            "code": "2084B0040X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": "NM",
            "license": "MD-2008-0223",
            "primary": false
        },
        {
            "code": "2084B0040X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": "GA",
            "license": "76623",
            "primary": false
        },
        {
            "code": "2084P0301X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Brain Injury Medicine",
            "state": "GA",
            "license": "76623",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NM",
            "license": "MD-2008-0223",
            "primary": false
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "GA",
            "license": "76623",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "GA",
            "license": "76623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "fkhan113458@nghs.gadirect.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "200 Wisteria Dr",
            "city": "Gainesville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "305013827",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kim Kerrick, PT
• Rebekah Ellen Mellor Ketterman
• Key Optique, LLC
• Jay Khambhati, MD
• Faria Memnum Khan, M.D.
• Hira Tariq Khan
• Imran Anwar Khan, MD
• Nidha Khan, DO, MPH
• Palwasha Khan, MD
• Sandus Khan

• Psychiatry Physician in Gainesville, GA
• Providers in Gainesville, GA by specialty
• Psychiatry Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.