Organization
KHAN INTERNAL MEDICINE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CLISTA P TALLENT (PRACTICE MANAGER)
(706) 279-1356
Entity
Organization
Contact information
Practice address
1407 CHATTANOOGA AVE, SUITE A, DALTON, GA 30720-2631
(706) 279-1356
(706) 279-1359
Mailing address
1407 CHATTANOOGA AVE, SUITE A, DALTON, GA 30720-2631
(706) 279-1356
(706) 279-1359
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
042315
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000728307O
—
GA
Enumeration date
07/31/2014
Last updated
07/31/2014
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