Provider Demographics
NPI:1053408062
Name:GOLDEN, CHRISTOPHER EARL GENE (PAC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:EARL GENE
Last Name:GOLDEN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 VILLAGE CTR PKWY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281
Mailing Address - Country:US
Mailing Address - Phone:770-474-5952
Mailing Address - Fax:770-474-1300
Practice Address - Street 1:210 VILLAGE CTR PKWY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281
Practice Address - Country:US
Practice Address - Phone:770-474-5952
Practice Address - Fax:770-474-1300
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002727207NI0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6536OtherKAISER
GAQ61481Medicare UPIN
GA97WCHGNMedicare PIN