NPIMap

Organization Active NPI

Khan Internal Medicine Center

  • Internal Medicine Physician
  • Dalton, GA
National Provider Identifier
1922416171
Registry record updated Jul 31, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
042315 Issued in GA
Legal business name
KHAN INTERNAL MEDICINE CENTER
Practice address
1407 Chattanooga Ave
Suite a
Dalton, GA 30720-2631
Phone
(706) 279-1356
Fax
(706) 279-1359
NPI assigned
Jul 31, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2014

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

Authorized official

Name
Mrs. Clista P Tallent
Title
Practice Manager
Phone
(706) 279-1356

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 042315 GA Primary

Addresses

Primary practice location

1407 Chattanooga Ave
Suite a
Dalton, GA 30720-2631

Mailing address

1407 Chattanooga Ave
Suite a
Dalton, GA 30720-2631
Phone (706) 279-1356

Other identifiers 1

IdentifierTypeStateIssuer
000728307OMedicaidGA

National Provider Directory

National Provider Directory

Locations

1407 Chattanooga Ave
#A
Dalton, GA 30720
Phone (706) 279-1356

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1406764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406764800000",
    "number": "1922416171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1407 CHATTANOOGA AVE",
            "address_2": "SUITE A",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307202631",
            "telephone_number": "706-279-1356",
            "fax_number": "706-279-1359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1407 CHATTANOOGA AVE",
            "address_2": "SUITE A",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307202631",
            "telephone_number": "706-279-1356",
            "fax_number": "706-279-1359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KHAN INTERNAL MEDICINE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-31",
        "last_updated": "2014-07-31",
        "status": "A",
        "authorized_official_last_name": "TALLENT",
        "authorized_official_first_name": "CLISTA",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "706-279-1356",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "042315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000728307O",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dalton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2014; 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.