Provider Demographics
NPI:1356323802
Name:EWART, CHRISTOPHER JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JAMES
Last Name:EWART
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 1:1348 WALTON WAY
Mailing Address - Street 2:SUITE 6300
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-5104
Mailing Address - Country:US
Mailing Address - Phone:706-724-5611
Mailing Address - Fax:706-724-5435
Practice Address - Street 1:1348 WALTON WAY
Practice Address - Street 2:SUITE 6300
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-5104
Practice Address - Country:US
Practice Address - Phone:706-724-5611
Practice Address - Fax:706-724-5435
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0529232086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG52923Medicaid
GA498281536AMedicaid
I29411Medicare UPIN
GA498281536AMedicaid