Provider Demographics
NPI:1396747077
Name:MACALUSO, CHRISTINA R (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:R
Last Name:MACALUSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:42 MAIN STREET
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:SENIOA
Mailing Address - State:GA
Mailing Address - Zip Code:30276
Mailing Address - Country:US
Mailing Address - Phone:770-400-9722
Mailing Address - Fax:678-723-4309
Practice Address - Street 1:42 MAIN STREET
Practice Address - Street 2:SUITE 2A
Practice Address - City:SENOIA
Practice Address - State:GA
Practice Address - Zip Code:30276
Practice Address - Country:US
Practice Address - Phone:770-400-9722
Practice Address - Fax:678-723-4309
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME81369207R00000X
GA73024207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF31433Medicare UPIN
FLE4762XMedicare PIN