Active NPI
Mojgan Khatami, MD
- Gynecology Physician
- Kennesaw, GA
National Provider Identifier
1770555070
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gynecology Physician
- License
- 42626
- Practice address
- 1690 Stone Village LN NW
Suite401
Kennesaw, GA 30152-7776 - Phone
- (770) 427-2533
- Fax
- (770) 427-2534
- NPI assigned
- Feb 2, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | 42626 | GA | Primary |
Addresses
Primary practice location
1690 Stone Village LN NW
Suite401
Kennesaw, GA 30152-7776
Mailing address
1690 Stone Village Lane, NW
Suite401
Kennesaw, GA 30152
Phone (770) 427-2533
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42626 | GA | MD | Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellstar Medical Group, LLC | Past | Accepting new patients |
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.
-
- Obstetrics & Gynecology Physician
- Austell, GA
- NPI 1013213651
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138838400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189123200000",
"number": "1770555070",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1690 STONE VILLAGE LANE, NW",
"address_2": "SUITE401",
"city": "KENNESAW",
"state": "GA",
"postal_code": "30152",
"telephone_number": "770-427-2533",
"fax_number": "770-944-0327"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1690 STONE VILLAGE LN NW",
"address_2": "SUITE401",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301527776",
"telephone_number": "770-427-2533",
"fax_number": "770-427-2534"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHATAMI",
"first_name": "MOJGAN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-02-02",
"last_updated": "2007-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "207VG0400X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": "GA",
"license": "42626",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kennesaw, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.