Provider Demographics
NPI:1932495728
Name:CHILDRESS, KRISTA JO (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:JO
Last Name:CHILDRESS
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 1:1975 CENTURY BLVD NE, SUITE 6
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345
Mailing Address - Country:US
Mailing Address - Phone:404-785-8787
Mailing Address - Fax:404-785-8788
Practice Address - Street 1:1405 CLIFTON RD.
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322
Practice Address - Country:US
Practice Address - Phone:404-785-8787
Practice Address - Fax:404-785-8788
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125059449207V00000X
GA078271207VG0400X, 207VX0000X
UT12619512-1205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics