Provider Demographics
NPI:1508243601
Name:CHRISTAKIS, GEORGIA (MD)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:CHRISTAKIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GEORGIA
Other - Middle Name:CHRISTAKIS
Other - Last Name:ELDRIDGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1011 NW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-3427
Mailing Address - Country:US
Mailing Address - Phone:561-302-5393
Mailing Address - Fax:
Practice Address - Street 1:333 CAMINO GARDENS BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5824
Practice Address - Country:US
Practice Address - Phone:613-924-4535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA278179208000000X
390200000X
FLME157572208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME157572OtherFLORIDA STATE MEDICAL LICENSE