Individual provider Active NPI

Mohammad A Khan, M.D.

  • Internal Medicine Physician
  • Marietta, GA
National Provider Identifier
1194792382
Registry record updated Dec 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
042314 Issued in GA
Practice address
754 Cherokee St NE
Suite a
Marietta, GA 30060-7209
Phone
(770) 428-8118
NPI assigned
Mar 7, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 26, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 042314 GA Primary

Addresses

Primary practice location

754 Cherokee St NE
Suite a
Marietta, GA 30060-7209

Mailing address

754 Cherokee St NE
Suite a
Marietta, GA 30060-7209
Phone (770) 428-8118

Other identifiers 2

IdentifierTypeStateIssuer
00728307NMedicaidGA
582587211OtherGATAX ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20040510000125 GA Practitioner - Internal MedicinePractitioner - Family Practice 8325037997 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Qcpi-Villagemd PCGroup PAC ID 8123389277, 76 clinicians

Practice addresses (Care Compare)

1805 Parke Plaza Cir
Suite 101
Stone Mountain, GA 30087-3646
Phone (770) 879-0436

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Stone Mountain Family Practice, PC Current Accepting new patients

Locations

1805 Parke Plaza Cir
Ste 101
Stone Mtn, GA 30087
Phone (770) 469-7000

Interoperability endpoints

  • Direct secure messaging: mohammad.khan.1@21533.direct.athenahealth.com

Organizations & group practices 2

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1141689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1356480000000",
    "number": "1194792382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "754 CHEROKEE ST NE",
            "address_2": "SUITE A",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607209",
            "telephone_number": "770-428-8118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "754 CHEROKEE ST NE",
            "address_2": "SUITE A",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607209",
            "telephone_number": "770-428-8118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "MOHAMMAD",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-07",
        "last_updated": "2012-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "042314",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00728307N",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "582587211",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.