Mubbashir Muzzammil Khan, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

054327 Issued in GA

Practice address

410 Shirley Ave
Douglas, GA 31533-2002

Phone

(912) 260-1206

NPI assigned

Jan 30, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: mubbashir.khan@gadirect.net

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.

• Senior Psych Solutions Corp

  • Clinical Social Worker
  • Atlanta, GA
  • NPI 1225078629
  NPD (past)

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429056000000",
    "number": "1871639237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 SHIRLEY AVE",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315332002",
            "telephone_number": "912-260-1206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 SHIRLEY AVE",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315332002",
            "telephone_number": "912-260-1206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "MUBBASHIR",
        "middle_name": "MUZZAMMIL",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2015-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "GA",
            "license": "054327",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003120037D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Umamaheswari Jonnalagadda, MD
• Karly Joyce, FNP-C
• Kaczor Enterprises Inc
• Lacey Kersey, FNP-C
• Hadequa Noor Khan, MD
• Vicki Kirkland, M. ED. CF-SLP
• Gregory J Kramer, D.P.M.
• Megan Lambert, MS, RD, LD
• Larry E. Forth O.D.P.C.
• Larry Hutchison DC PC

• Psychiatry Physician in Douglas, GA
• Providers in Douglas, GA by specialty
• Psychiatry Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.