Provider Demographics
NPI:1003850983
Name:CORWIN, CHRISTOPHER RUSSEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:RUSSEL
Last Name:CORWIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CIRCLE 75 PKWY.
Mailing Address - Street 2:STE. 900
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3084
Mailing Address - Country:US
Mailing Address - Phone:678-426-2171
Mailing Address - Fax:404-446-1957
Practice Address - Street 1:11459 JOHNS CREEK PKWY.
Practice Address - Street 2:STE. 260
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-3515
Practice Address - Country:US
Practice Address - Phone:770-232-5030
Practice Address - Fax:770-495-9993
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001012213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003132092BMedicaid
GA003132092BMedicaid