Provider Demographics
NPI:1003095753
Name:CHRISTOPHER A. KUETTNER, MD
Entity Type:Organization
Organization Name:CHRISTOPHER A. KUETTNER, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KUETTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-756-3872
Mailing Address - Street 1:9976 FORD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-3900
Mailing Address - Country:US
Mailing Address - Phone:912-756-3872
Mailing Address - Fax:912-756-5355
Practice Address - Street 1:9976 FORD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3900
Practice Address - Country:US
Practice Address - Phone:912-756-3872
Practice Address - Fax:912-756-5355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA24008207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP1720Medicare PIN