Provider Demographics
NPI:1841239555
Name:HADDOCK, CHRISTOPHER G (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:G
Last Name:HADDOCK
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 1:60 ERLANGER SOUTH DR STE A
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-3179
Mailing Address - Country:US
Mailing Address - Phone:423-778-2900
Mailing Address - Fax:706-937-7207
Practice Address - Street 1:60 ERLANGER SOUTH DR STE A
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-3179
Practice Address - Country:US
Practice Address - Phone:423-778-2900
Practice Address - Fax:706-937-7207
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053921207Q00000X
TN053921207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA053921OtherMEDICAL LICENSE
TN35545OtherMEDICAL LICENSE
TNH41035Medicare UPIN
TN3865707Medicaid