Provider Demographics
NPI:1659460244
Name:HAGENSTAD, CHRISTOPHER T (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:T
Last Name:HAGENSTAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 PROFESSIONAL DRIVE
Mailing Address - Street 2:STE 210
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046
Mailing Address - Country:US
Mailing Address - Phone:678-312-3235
Mailing Address - Fax:678-312-2020
Practice Address - Street 1:631 PROFESSIONAL DRIVE
Practice Address - Street 2:STE 210
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046
Practice Address - Country:US
Practice Address - Phone:678-312-3235
Practice Address - Fax:678-312-2020
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052738207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1508926759OtherGROUP NPI NUMBER
GA1659460244OtherPROVIDER NPI NUMBER
GA001888315AMedicaid
GA1659460244OtherPROVIDER NPI NUMBER
P00024271Medicare PIN
GA001888315AMedicaid
H84056Medicare UPIN
GA4188940001Medicare NSC