Provider Demographics
NPI:1952734436
Name:NOGUERA, CHRISTINA LEIGH HUNTLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA LEIGH
Middle Name:HUNTLEY
Last Name:NOGUERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:LEIGH
Other - Last Name:HUNTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:915 W GORDON ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-3427
Mailing Address - Country:US
Mailing Address - Phone:706-647-7009
Mailing Address - Fax:706-647-7014
Practice Address - Street 1:915 W GORDON ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3427
Practice Address - Country:US
Practice Address - Phone:706-647-7009
Practice Address - Fax:706-647-7014
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA79511207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program