Provider Demographics
NPI:1689682395
Name:AL KHOURY, SALWA FAHED (MD)
Entity type:Individual
Prefix:
First Name:SALWA
Middle Name:FAHED
Last Name:AL KHOURY
Suffix:
Gender:F
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:PO BOX 15004
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37901-5004
Mailing Address - Country:US
Mailing Address - Phone:865-541-8895
Mailing Address - Fax:865-633-4808
Practice Address - Street 1:1400 DUTCH VALLEY DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-1424
Practice Address - Country:US
Practice Address - Phone:865-689-1122
Practice Address - Fax:866-340-3781
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35936208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ007692Medicaid
TN3497083Medicaid
TN4148577OtherBCBS
TN4148577OtherBCBS