Basic Information
| Provider Information | |||||||||
| NPI: | 1679736938 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KHALDI | ||||||||
| FirstName: | AHMAD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 61 WHITCHER ST NE STE 3110 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300601179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704222326 | ||||||||
| FaxNumber: | 7704227797 | ||||||||
| Practice Location | |||||||||
| Address1: | 61 WHITCHER STREET | ||||||||
| Address2: | SUITE 3110 | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704222326 | ||||||||
| FaxNumber: | 7704227797 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2008 | ||||||||
| LastUpdateDate: | 11/05/2019 | ||||||||
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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 | 2085R0202X | MD039565 | DC | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 282N00000X | 125046943 | IL | N | Hospitals | General Acute Care Hospital | 282N00000X | 0101249516 | VA | N | Hospitals | General Acute Care Hospital | 282N00000X | FK1937359 | DC | N | Hospitals | General Acute Care Hospital | 282N00000X | D0072280 | MD | N | Hospitals | General Acute Care Hospital | 207T00000X | 68224 | GA | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.