Provider Demographics
NPI:1568553196
Name:CHRISTIAN, TALMADGE LAMONT (CSA)
Entity Type:Individual
Prefix:MR
First Name:TALMADGE
Middle Name:LAMONT
Last Name:CHRISTIAN
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4426 HUGH HOWELL RD
Mailing Address - Street 2:SUITE B-158
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4918
Mailing Address - Country:US
Mailing Address - Phone:678-642-4736
Mailing Address - Fax:770-938-2017
Practice Address - Street 1:4426 HUGH HOWELL RD
Practice Address - Street 2:SUITE B-158
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4918
Practice Address - Country:US
Practice Address - Phone:678-642-4736
Practice Address - Fax:770-938-2017
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2670246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA75-3205899OtherEIN