Provider Demographics
NPI:1508811712
Name:GHALEB, CHRISTIANNA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIANNA
Middle Name:MARIE
Last Name:GHALEB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 US HIGHWAY 80 W
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-2509
Mailing Address - Country:US
Mailing Address - Phone:912-748-1100
Mailing Address - Fax:912-748-1004
Practice Address - Street 1:433 US HIGHWAY 80 W
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-2509
Practice Address - Country:US
Practice Address - Phone:912-748-1100
Practice Address - Fax:912-748-1004
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056554207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10065420OtherAMERIGROUP
GA680312905BMedicaid
GA349772OtherWELLCARE
SCG56554Medicaid
GAP00268076OtherRAILROAD MEDICARE
GA680312905AMedicaid
I41331Medicare UPIN
GA680312905AMedicaid