Provider Demographics
NPI:1841797289
Name:UTHAMAN, CHRISTAL MARIE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTAL
Middle Name:MARIE
Last Name:UTHAMAN
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 1:3780 EISENHOWER PKWY
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-0800
Mailing Address - Country:US
Mailing Address - Phone:478-633-5550
Mailing Address - Fax:478-633-7287
Practice Address - Street 1:500 OLD YORK ROAD
Practice Address - Street 2:SUITE 203
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046
Practice Address - Country:US
Practice Address - Phone:214-886-0174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10546207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine