Provider Demographics
NPI:1760539175
Name:RUSH, CHRISTA LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:LEE
Last Name:RUSH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:CHRISTA
Other - Middle Name:LEE
Other - Last Name:PARTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:103 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:HIAWASSEE
Mailing Address - State:GA
Mailing Address - Zip Code:30546-3223
Mailing Address - Country:US
Mailing Address - Phone:706-896-4673
Mailing Address - Fax:706-896-3992
Practice Address - Street 1:200 W ACADEMY STREET
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:770-282-8820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4437363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA727928896OMedicaid