Provider Demographics
NPI:1548222094
Name:AL-KHALDI, AOUS S (MD)
Entity type:Individual
Prefix:DR
First Name:AOUS
Middle Name:S
Last Name:AL-KHALDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 JADE SPRING CT.
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117
Mailing Address - Country:US
Mailing Address - Phone:704-987-1498
Mailing Address - Fax:304-598-2293
Practice Address - Street 1:1601 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3431
Practice Address - Country:US
Practice Address - Phone:478-333-3603
Practice Address - Fax:478-333-3685
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC40219032085R0202X
WV018142085R0202X
GA0540572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810010201Medicaid
GA52388731 003OtherBCBSGA
GAP01064760OtherRAILROAD MEDICARE
GA003125445BMedicaid
NCP00466058OtherRAILROAD MEDICARE
WV1072273OtherWORKERS COMPENSATION
GA52388731 002OtherBCBSGA
GA003125445AMedicaid
GA202I301188Medicare PIN
GA52388731 002OtherBCBSGA
GAP01064760OtherRAILROAD MEDICARE
NCP00466058OtherRAILROAD MEDICARE
C89048Medicare UPIN