Provider Demographics
NPI:1922212711
Name:KILLINGSWORTH, CHRISTOPHER DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:KILLINGSWORTH
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 1:4005 FELTON CIR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-3794
Mailing Address - Country:US
Mailing Address - Phone:770-807-4940
Mailing Address - Fax:
Practice Address - Street 1:4150 DEP BILL CANTRELL MEMORIAL RD STE 240
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-3024
Practice Address - Country:US
Practice Address - Phone:678-208-6008
Practice Address - Fax:678-208-6375
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA67666208200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1992063606Medicare UPIN