Provider Demographics
NPI:1174181671
Name:KHAN, JANNAT MUJAHID (MD)
Entity type:Individual
Prefix:
First Name:JANNAT
Middle Name:MUJAHID
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 NC HIGHWAY 125
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-6460
Mailing Address - Country:US
Mailing Address - Phone:252-537-5631
Mailing Address - Fax:
Practice Address - Street 1:171 NC HIGHWAY 125
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-6460
Practice Address - Country:US
Practice Address - Phone:252-537-5631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301506316207X00000X
MDD0100113208200000X
NC202502827207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery