Provider Demographics
NPI:1386750586
Name:TABRIZI, KHALIL (RPH)
Entity type:Individual
Prefix:
First Name:KHALIL
Middle Name:
Last Name:TABRIZI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4479 HICKORY WOOD LN
Mailing Address - Street 2:
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30360-2657
Mailing Address - Country:US
Mailing Address - Phone:770-449-1665
Mailing Address - Fax:
Practice Address - Street 1:4479 HICKORY WOOD LN
Practice Address - Street 2:
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30360-2657
Practice Address - Country:US
Practice Address - Phone:770-449-1665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH013360282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital