Organization
PEDIATRIC NEUROLOGY AND EPILEPSY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AIJAZ A KHALID M.D. (PHYSICIAN)
(770) 596-4631
Entity
Organization
Contact information
Practice address
170 CAMDEN HILL RD, A, LAWRENCEVILLE, GA 30046-7418
(770) 596-4631
(678) 990-8019
Mailing address
170 CAMDEN HILL RD, SUITE A, LAWRENCEVILLE, GA 30046-7418
(770) 596-4631
(678) 990-8019
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
38271
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
602609808A
—
GA
Enumeration date
01/11/2012
Last updated
01/11/2012
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