Provider Demographics
NPI:1366598799
Name:KHICHI, ANITA SINGH (MD)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:SINGH
Last Name:KHICHI
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:PO BOX 116156
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-6156
Mailing Address - Country:US
Mailing Address - Phone:470-325-0100
Mailing Address - Fax:470-325-0193
Practice Address - Street 1:555 OLD NORCROSS RD
Practice Address - Street 2:SUITE 210
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8716
Practice Address - Country:US
Practice Address - Phone:678-312-5250
Practice Address - Fax:678-442-7648
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA40120208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000679313Medicaid