Provider Demographics
NPI:1902596067
Name:KHAN, FAIZA SHAKEEL
Entity Type:Individual
Prefix:
First Name:FAIZA
Middle Name:SHAKEEL
Last Name:KHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 OAK ALLEY CT
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8032
Mailing Address - Country:US
Mailing Address - Phone:678-576-7563
Mailing Address - Fax:
Practice Address - Street 1:7 DUNWOODY PARK STE 104
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6711
Practice Address - Country:US
Practice Address - Phone:678-576-7563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
GA1-24-71875103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician