Provider Demographics
NPI:1013906130
Name:CHRISTIANSEN FORD, CAREY L (MD)
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:L
Last Name:CHRISTIANSEN FORD
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 1:60 EXCHANGE ST STE B7
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-7646
Mailing Address - Country:US
Mailing Address - Phone:912-756-2273
Mailing Address - Fax:
Practice Address - Street 1:60 EXCHANGE ST STE B7
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-7646
Practice Address - Country:US
Practice Address - Phone:912-756-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23318207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEI37672Medicare UPIN