Provider Demographics
NPI:1609861137
Name:CHRIS RECKNOR, M.D. PC
Entity Type:Organization
Organization Name:CHRIS RECKNOR, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:P
Authorized Official - Last Name:RECKNOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-534-5154
Mailing Address - Street 1:PO BOX 908063
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-0916
Mailing Address - Country:US
Mailing Address - Phone:770-534-5154
Mailing Address - Fax:770-503-0183
Practice Address - Street 1:2350 LIMESTONE PKWY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2087
Practice Address - Country:US
Practice Address - Phone:770-534-5154
Practice Address - Fax:770-503-0183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000680787HMedicaid
GA5226490001Medicare NSC
GA000680787HMedicaid
GAGRP7273Medicare PIN