Shazib N. Khawaja, MD

Primary specialty

Interventional Cardiology PhysicianTaxonomy code 207RI0011X

License

058888 Issued in GA

Practice address

705 Dixie St
Suite 401
Carrollton, GA 30117-3818

Phone

(770) 836-9326

NPI assigned

May 20, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in AL, GA2 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 2

Specialty

Cardiovascular Disease (Cardiology)

Education

University of South Alabama College of Medicine, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Tanner Medical Group IncGroup PAC ID 2769536143, 120 clinicians

Wedowee Specialty Clinic IncGroup PAC ID 8325447642, 6 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tanner Medical Center - Carrollton Hospital, Carrollton, GA, CCN 110011
• Tanner Medical Center-East Alabama Hospital, Wedowee, AL, CCN 011306
• Tanner Medical Center Villa Rica Hospital, Villa Rica, GA, CCN 110015

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Tanner Medical Group Inc

  • Cardiovascular Disease Physician
  • Carrollton, GA
  • NPI 1396979787

  AL

  Medicare reassignment Care Compare group NPD
• Wedowee Specialty Clinic Inc

  • Cardiovascular Disease Physician
  • Wedowee, AL
  • NPI 1275115362
  Medicare reassignment Care Compare group NPD
• Tanner Primary Care of Wedowee Inc

  dba Wedowee Rural Health

  • Rural Health Clinic/Center
  • Wedowee, AL
  • NPI 1396002515
  Medicare reassignment NPD
• TMC Woodland Family Healthcare, Inc.

  dba Woodland Family Healthcare

  • Rural Health Clinic/Center
  • Woodland, AL
  • NPI 1467600916
  Medicare reassignment NPD
• Carrollton Surgical Group, P. a.

  • Surgery Physician
  • Carrollton, GA
  • NPI 1417931825
  NPD (past)
• TMC Children's Healthcare of West Georgia

  • Medical Specialty Clinic/Center
  • Carrollton, GA
  • NPI 1518972348
  NPD (past)

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

• Tanner Medical Center, Inc

  dba Tanner Health System

  • General Acute Care Hospital
  • Carrollton, GA
  • NPI 1801883780
  Care Compare affiliation
• TMC/Villa Rica Hospital, Inc

  dba Tanner Health System

  • General Acute Care Hospital
  • Villa Rica, GA
  • NPI 1851388748
  Care Compare affiliation
• Tanner Medical Center Alabama Inc

  dba Tanner Medical Center East Alabama

  • Critical Access Hospital
  • Wedowee, AL
  • NPI 1912428301
  Care Compare affiliation

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438646400000",
    "number": "1417901604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 AMBULANCE DR 202",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173857",
            "telephone_number": "770-838-8710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 DIXIE ST",
            "address_2": "SUITE 401",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173818",
            "telephone_number": "770-836-9326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAWAJA",
        "first_name": "SHAZIB",
        "middle_name": "N.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-20",
        "last_updated": "2015-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "GA",
            "license": "058888",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "GA",
            "license": "058888",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "AL",
            "license": "25860",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009949425",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08537330",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "51521327",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269454900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "2510927",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kyle Garrett Kelly, CRNA
• Jailyn S Kendrick, RN
• Nikki Kennedy
• Cathleen E Kessler, NP
• Khawaja Dental, LLC
• Kallista Kilgore, NP
• Shanequa Kimble, LCSW
• Jacob Mitchell Kincaid
• Pamela Kinnebrew
• Bryan P Kirby, M.D.

• Interventional Cardiology Physician in Carrollton, GA
• Providers in Carrollton, GA by specialty
• Interventional Cardiology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.