Provider Demographics
NPI:1679665558
Name:DANFORTH, CHRISTINE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:MARIE
Last Name:DANFORTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 METROPOLITAN PKWY SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-7914
Mailing Address - Country:US
Mailing Address - Phone:404-905-9200
Mailing Address - Fax:404-815-4300
Practice Address - Street 1:2720 METROPOLITAN PKWY SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-7914
Practice Address - Country:US
Practice Address - Phone:404-905-9200
Practice Address - Fax:404-815-4300
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0007935480Medicaid
GA42503OtherLICENSE
GABS5892939OtherDEA REGISTRATION
GA000793548GMedicaid