Individual provider Active NPI

Asra Y Khan, PA-C

  • Physician Assistant
  • Marietta, GA
National Provider Identifier
1497408025
Registry record updated Oct 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
001013335 Issued in NC
Practice address
45 South Ave SE Ste 5
Marietta, GA 30060-2538
Phone
(919) 391-7202
NPI assigned
Feb 2, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 001013335 NC Primary

Addresses

Primary practice location

45 South Ave SE Ste 5
Marietta, GA 30060-2538

Mailing address

5501 Fortunes Ridge Dr Ste P
Durham, NC 27713-6102
Phone (919) 391-7202

Other practice location 1

5501 Fortunes Ridge Dr Ste P
Durham, NC 27713-6102
Phone (919) 391-7202

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, GA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20241111002889 NC Practitioner - Physician Assistant 9133653330 Reassigns benefits to 1 organization
I20241223002701 GA Practitioner - Physician Assistant 9133653330 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Animo Sano Psychiatry PLLCGroup PAC ID 8729489182, 53 clinicians

Practice addresses (Care Compare)

45 S Ave SE
Suite 5
Marietta, GA 30060-2538
Phone (919) 391-7202

5501 Fortunes Ridge Dr
Suite P
Durham, NC 27713-6102
Phone (919) 391-7202

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
001013335NCMDPhysician Assistant

Organizations & group practices 1

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": "1643760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760227200000",
    "number": "1497408025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5501 FORTUNES RIDGE DR STE P",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277136102",
            "telephone_number": "919-391-7202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 SOUTH AVE SE STE 5",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300602538",
            "telephone_number": "919-391-7202"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5501 Fortunes Ridge Dr Ste P",
            "address_purpose": "LOCATION",
            "city": "Durham",
            "state": "NC",
            "postal_code": "277136102",
            "country_code": "US",
            "telephone_number": "919-391-7202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHAN",
        "first_name": "ASRA",
        "middle_name": "Y",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-02",
        "last_updated": "2025-10-12",
        "certification_date": "2025-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "001013335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.