Basic Information
| Provider Information | |||||||||
| NPI: | 1174939060 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GHAFOOR | ||||||||
| FirstName: | KHUZEMA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1345 HARDEMAN AVE APT 427 | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312011439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014284027 | ||||||||
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| Practice Location | |||||||||
| Address1: | 777 HEMLOCK ST | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312012102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4786337550 | ||||||||
| FaxNumber: | 4786333235 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301105676 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 77626 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.