Provider Demographics
NPI:1689635161
Name:AHMAD, KHIZER KHURSHID (MD)
Entity type:Individual
Prefix:
First Name:KHIZER
Middle Name:KHURSHID
Last Name:AHMAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 REINHARDT COLLEGE PKWY
Mailing Address - Street 2:BLDG 100 SUITE 100
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114
Mailing Address - Country:US
Mailing Address - Phone:770-479-1985
Mailing Address - Fax:770-479-4839
Practice Address - Street 1:15 REINHARDT COLLEGE PKWY
Practice Address - Street 2:BLDG 100 SUITE 100
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114
Practice Address - Country:US
Practice Address - Phone:770-479-1985
Practice Address - Fax:770-479-4839
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042511208000000X
IN01046250208000000X
FLME74728208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics