Provider Demographics
NPI:1831223049
Name:KHOURY, CHAOUKI K (MD, MS)
Entity type:Individual
Prefix:DR
First Name:CHAOUKI
Middle Name:K
Last Name:KHOURY
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5887 GLENRIDGE DR STE 140
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-6191
Mailing Address - Country:US
Mailing Address - Phone:678-705-7341
Mailing Address - Fax:678-973-0578
Practice Address - Street 1:5887 GLENRIDGE DR STE 140
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-6191
Practice Address - Country:US
Practice Address - Phone:678-705-7341
Practice Address - Fax:678-973-0578
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK222962084N0402X
TXP11892084N0402X
GA0835962084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX291823701Medicaid
TXP01062436Medicare PIN
TX291823701Medicaid
246726105Medicare PIN