Provider Demographics
NPI:1558814137
Name:INGHAM, CRISTEN RAY (PA-C)
Entity Type:Individual
Prefix:
First Name:CRISTEN
Middle Name:RAY
Last Name:INGHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CRISTEN
Other - Middle Name:LEA
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8880 ABERCORN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4508
Mailing Address - Country:US
Mailing Address - Phone:912-231-4444
Mailing Address - Fax:912-231-4440
Practice Address - Street 1:8880 ABERCORN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4508
Practice Address - Country:US
Practice Address - Phone:912-231-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7971363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant