Provider Demographics
NPI:1073790622
Name:CHRISTIE, DUDLEY BENJAMIN III (MD)
Entity Type:Individual
Prefix:
First Name:DUDLEY
Middle Name:BENJAMIN
Last Name:CHRISTIE
Suffix:III
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 1:840 PINE ST STE 750
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-7528
Mailing Address - Country:US
Mailing Address - Phone:478-633-1458
Mailing Address - Fax:478-633-5025
Practice Address - Street 1:840 PINE ST STE 750
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7528
Practice Address - Country:US
Practice Address - Phone:478-633-1458
Practice Address - Fax:478-633-5025
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000566208600000X
GA0605682086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery