Provider Demographics
NPI:1396788592
Name:INHULSEN, CHRISTOPHER RODERICK (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:RODERICK
Last Name:INHULSEN
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 1:300 MEDICAL COURT
Mailing Address - Street 2:
Mailing Address - City:OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:31068-0343
Mailing Address - Country:US
Mailing Address - Phone:478-458-9942
Mailing Address - Fax:478-458-9969
Practice Address - Street 1:300 MEDICAL COURT
Practice Address - Street 2:
Practice Address - City:OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:31068-0343
Practice Address - Country:US
Practice Address - Phone:478-458-9942
Practice Address - Fax:478-458-9969
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20743207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000183235DMedicaid
GA00183235Medicaid
GA00183235Medicaid
GA253974839BMedicare ID - Type Unspecified