Provider Demographics
NPI:1306832175
Name:RECKNOR, CHRISTOPHER P (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:P
Last Name:RECKNOR
Suffix:
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:PO BOX 908063
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-0916
Mailing Address - Country:US
Mailing Address - Phone:770-534-5154
Mailing Address - Fax:770-503-0183
Practice Address - Street 1:2350 LIMESTONE PKWY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2087
Practice Address - Country:US
Practice Address - Phone:770-534-5154
Practice Address - Fax:770-503-0183
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040982207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00680787HMedicaid
GA00680787JMedicaid
GAGRP7273Medicare PIN
GA11BDPPJMedicare PIN
GA00680787HMedicaid
GA00680787JMedicaid