Provider Demographics
NPI:1396840120
Name:TIMMINS, CHRISTOPHER LOUIS (APRN)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:LOUIS
Last Name:TIMMINS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 BLUE RIDGE OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-4431
Mailing Address - Country:US
Mailing Address - Phone:706-946-5600
Mailing Address - Fax:706-374-7628
Practice Address - Street 1:3991 DUTCHMANS LN STE 205
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4723
Practice Address - Country:US
Practice Address - Phone:502-899-6170
Practice Address - Fax:502-899-6179
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN202115363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA403251185EMedicaid
GRP 1855OtherMEDICARE GROUP PTAN
GARN202115NPOtherLICENSE
111832OtherMEDICARE PTAN