Basic Information
| Provider Information | |||||||||
| NPI: | 1215166780 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHAN | ||||||||
| FirstName: | MOIZ | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 744786 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303744786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048342450 | ||||||||
| FaxNumber: | 7046715331 | ||||||||
| Practice Location | |||||||||
| Address1: | 660 SUMMIT CROSSING PL STE 301 | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280542181 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048670735 | ||||||||
| FaxNumber: | 7048670738 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2009 | ||||||||
| LastUpdateDate: | 10/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 64694 | CT | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 64694 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 2021-01333 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.