Provider Demographics
NPI:1447296199
Name:REHMAN, KHALIQUE U (MD)
Entity type:Individual
Prefix:DR
First Name:KHALIQUE
Middle Name:U
Last Name:REHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:245 VILLAGE CENTER PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9096
Mailing Address - Country:US
Mailing Address - Phone:770-288-3311
Mailing Address - Fax:770-288-3824
Practice Address - Street 1:245 VILLAGE CENTER PKWY
Practice Address - Street 2:# 130
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9096
Practice Address - Country:US
Practice Address - Phone:770-288-3311
Practice Address - Fax:770-288-3824
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054116208VP0014X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI21785Medicare UPIN