Provider Demographics
NPI:1922744622
Name:CASIMIR, CHRISTIAN KYLE
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:KYLE
Last Name:CASIMIR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 HAYDENS RDG
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-4515
Mailing Address - Country:US
Mailing Address - Phone:404-205-3436
Mailing Address - Fax:
Practice Address - Street 1:844 HAYDENS RDG
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-4515
Practice Address - Country:US
Practice Address - Phone:404-205-3436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053358931172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver