Individual provider · NPI-1

Khaldoon J Al-Moosawi, M.D.

Family Medicine, Sleep Medicine · Suwanee, GA

NPI number1578849444

StatusActive

Last updated in NPPESNov 8, 2016

Details

NPI: 1578849444
Entity type: Individual (NPI-1)
Name: Khaldoon J Al-Moosawi
Credential: M.D.
Sex: Male
Sole proprietor: No
Enumeration date: Oct 24, 2011
Last updated: Nov 8, 2016

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
207QS1201X	Family Medicine, Sleep Medicine	069749	GA	Yes
207Q00000X	Family Medicine	005364	GA
207QS1201X	Family Medicine, Sleep Medicine	2015-00835	NC
207QS1201X	Family Medicine, Sleep Medicine	69749	GA
390200000X	Student in an Organized Health Care Education/Training Program	2015-00835	NC
207Q00000X	Family Medicine	069749	GA

Practice location

4245 Johns Creek Pkwy
Suite A
Suwanee, GA 30024-9122

Phone 678-990-3962 · Fax 678-840-3777

Mailing address

4245 Johns Creek Pkwy
Suite A
Suwanee, GA 30024-9122

Phone 678-990-3962 · Fax 678-840-3777

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