Individual provider Active NPI

Noor Khan

  • Physician Assistant
  • Lawrenceville, GA
National Provider Identifier
1205628864
Registry record updated Aug 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
771 Old Norcross Rd Ste 200
Lawrenceville, GA 30046-4980
Phone
(770) 339-1387
Fax
(770) 962-7868
NPI assigned
May 20, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 14, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 13322 GA
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

771 Old Norcross Rd Ste 200
Lawrenceville, GA 30046-4980

Mailing address

420 E 70TH St Apt 9D3
New York, NY 10021-5354
Phone (404) 966-4503

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251029004185 GA Practitioner - Physician Assistant 1951890912 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

771 Old Norcross Rd
Suite 200
Lawrenceville, GA 30046-4980

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
13322GAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
North Atlanta Endocrinology and Diabetes, PC CurrentSince Nov 1, 2025 Accepting new patients
Openloop Healthcare Partners PC Physician Assistant PastSince Aug 17, 2025 Accepting new patients

Locations

771 Old Norcross Rd
Ste 200
Lawrenceville, GA 30046
Phone (770) 339-1387

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.400261

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.

NPI Registry JSON

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

{
    "created_epoch": "1747699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755129600000",
    "number": "1205628864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 E 70TH ST APT 9D3",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100215354",
            "telephone_number": "404-966-4503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "771 OLD NORCROSS RD STE 200",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300464980",
            "telephone_number": "770-339-1387",
            "fax_number": "770-962-7868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "NOOR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-05-20",
        "last_updated": "2025-08-14",
        "certification_date": "2025-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "13322",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.