Active NPI
Mohammad Raza Khan
- Student in an Organized Health Care Education/Training Program
- Austell, GA
National Provider Identifier
1659263317
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 3950 Austell Rd
Austell, GA 30106-1121 - Phone
- (770) 941-3181
- NPI assigned
- Jul 17, 2025
- Last updated
- Jul 17, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
3950 Austell Rd
Austell, GA 30106-1121
Mailing address
3890 Floyd Rd Apt 3305
Austell, GA 30106-1535
Phone (678) 496-1109
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250813001877 | GA | Order and Referring Only - Internal Medicine | 7315445871 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18117 | GA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1752710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752710400000",
"number": "1659263317",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3890 FLOYD RD APT 3305",
"city": "AUSTELL",
"state": "GA",
"postal_code": "301061535",
"telephone_number": "678-496-1109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3950 AUSTELL RD",
"city": "AUSTELL",
"state": "GA",
"postal_code": "301061121",
"telephone_number": "770-941-3181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHAN",
"first_name": "MOHAMMAD",
"middle_name": "RAZA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-07-17",
"last_updated": "2025-07-17",
"certification_date": "2025-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austell, GA
- Kennestone Hospital, Inc (WellStar Pharmacy Network)
- Kennestone Hosptial, Inc. (WellStar Behavioral Health)
- Kevin Wayne Kersee Jr., D.C.
- Christine M Keyser, DMD
- Mali Khamissi Sobi
- Muhammad Aizaz Mohsin Khan, MBCHB
- Nabeel A Khan, MD
- Anshika Payal Khare, MD
- Agnes Kim, PT, DPT
- Daisy Melinda King-Godineaux, FNP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2025; 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.