Provider Demographics
NPI:1710010566
Name:SPRINGSTON, CHRISTA R (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTA
Middle Name:R
Last Name:SPRINGSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:CHRISTA
Other - Middle Name:R
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 MILLBROOK VILLAGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-3605
Mailing Address - Country:US
Mailing Address - Phone:470-615-7224
Mailing Address - Fax:470-447-1872
Practice Address - Street 1:120 MILLBROOK VILLAGE DR STE 200
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-3605
Practice Address - Country:US
Practice Address - Phone:470-615-7224
Practice Address - Fax:470-447-1872
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA073837207R00000X
IL036124836207R00000X, 208M00000X
DEC7-0003481207R00000X
MO2008017954207R00000X
TXN6677207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$Medicaid
ILIL3374037Medicare PIN