Wardah Khalid, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

8864 Issued in GA

Practice address

5300 Oakbrook Pkwy Ste 130
Norcross, GA 30093-2261

Phone

(770) 806-2928

NPI assigned

Oct 30, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Four Corners Primary Care Centers, Inc. 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Four Corners Primary Care Centers Inc

  • Federally Qualified Health Center (FQHC)
  • Norcross, GA
  • NPI 1265624548

  GA

  Medicare reassignment Care Compare group NPD
• Four Corners Primary Care Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Lawrenceville, GA
  • NPI 1285325282
  Care Compare group NPD
• Four Corners Primary Care Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Lawrenceville, GA
  • NPI 1356682959
  Care Compare group NPD (past)
• Four Corners Primary Care Centers Inc

  • Federally Qualified Health Center (FQHC)
  • Hoschton, GA
  • NPI 1548622285
  Care Compare group

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

{
    "created_epoch": "1540857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540857600000",
    "number": "1972070779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3353 FORESTWOOD DR",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300244604",
            "telephone_number": "770-653-6321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 OAKBROOK PKWY STE 130",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300932261",
            "telephone_number": "770-806-2928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHALID",
        "first_name": "WARDAH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-30",
        "last_updated": "2018-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "8864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michaelene Sage Kearney, OTR/L.
• Sosena Kebede, MD
• Keen Behavioral Solutions LLC
• Isabelle Kelly
• Donald Craig Kerley, PSY.D.
• Melissa Tucker Khan, PA-C
• Viswanatha Kharidi, MD
• Raymond S Kiertekles, PH.D.
• Ann Jungsun Kim, APRN
• Gene Young Kim

• All providers in Norcross, GA
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.