Provider Demographics
NPI:1134151582
Name:HART, CHRISTOPHER JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:HART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6920 MCGINNIS FERRY RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1258
Mailing Address - Country:US
Mailing Address - Phone:770-232-2911
Mailing Address - Fax:770-232-2996
Practice Address - Street 1:6920 MCGINNIS FERRY RD
Practice Address - Street 2:SUITE 340
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1258
Practice Address - Country:US
Practice Address - Phone:770-232-2911
Practice Address - Fax:770-232-2996
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA43637208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA606745OtherBLUE CROSS BLUE SHIELD
GA5745583OtherAETNA
GA606745OtherBLUE CROSS BLUE SHIELD
GA02BBCSRMedicare ID - Type Unspecified