Provider Demographics
NPI:1316349038
Name:HAQ, KHWAJA FAHAD (MD)
Entity type:Individual
Prefix:DR
First Name:KHWAJA
Middle Name:FAHAD
Last Name:HAQ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3825 MEDICAL PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-6831
Mailing Address - Country:US
Mailing Address - Phone:470-267-1764
Mailing Address - Fax:470-986-7002
Practice Address - Street 1:677 CHURCH ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1101
Practice Address - Country:US
Practice Address - Phone:470-267-1764
Practice Address - Fax:470-986-7002
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2022-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101275676207RG0100X
NY311119207RG0100X
MI4301114404390200000X
GA91748207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program