Individual
DR. AYESHA KHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
333 MIDWAY RD NW, MARIETTA, GA 30064-5630
(984) 283-1722
(888) 498-3729
Mailing address
1587 PETAL PT NW, KENNESAW, GA 30152-7773
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
058338
GA
207R00000X
Internal Medicine Physician
2016-00151
NC
208D00000X
General Practice Physician
058338
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1609816123
GEORGIA CLINIC PC GROUP NPI #
GA
01
—
2016-00151
NORTH CAROLINA MEDICAL BOARD LICENSE
NC
05
—
471357534D
—
GA
05
—
471357534E
—
GA
05
—
471357534F
—
GA
Enumeration date
11/14/2006
Last updated
03/07/2025
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