Provider Demographics
NPI:1659550093
Name:CHRISTMANN, LINDA MEWIS (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MEWIS
Last Name:CHRISTMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:MEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5308 FAIRFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-8028
Mailing Address - Country:US
Mailing Address - Phone:252-218-2996
Mailing Address - Fax:318-448-4903
Practice Address - Street 1:3495 PIEDMONT ROAD, NE, BLDG. 9
Practice Address - Street 2:THE SOUTHEAST PERMANENTE MEDICAL GROUP, INC.
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305
Practice Address - Country:US
Practice Address - Phone:404-364-4272
Practice Address - Fax:318-448-4903
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01550207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDM0772Medicaid
SCDM0772Medicaid