Provider Demographics
NPI:1528115326
Name:ALKHATIB, MHD ANAS (MD)
Entity type:Individual
Prefix:
First Name:MHD ANAS
Middle Name:
Last Name:ALKHATIB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANAS
Other - Middle Name:
Other - Last Name:ALKHATIB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2150 PEACHFORD RD
Mailing Address - Street 2:SUITE Q
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6520
Mailing Address - Country:US
Mailing Address - Phone:678-615-7032
Mailing Address - Fax:
Practice Address - Street 1:750 HAMMOND DR STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5532
Practice Address - Country:US
Practice Address - Phone:678-615-7032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0655602084P0800X, 2084P0804X
AL267852084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65560OtherLISC