MEDICARE: CHRISTINE M LOCKHART CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R125749	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003854373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE M LOCKHART CNP

Provider Business Mailing Address
First Line	:	920 CAIRO RD
Second Line	:
City	:	THOMASVILLE
State	:	GA
Zip	:	31792-4255
Country	:	US
Telephone Number	:	229-227-5500
Fax Number	:	229-227-5505

Provider Business Practice Location Address
First Line	:	259 US HIGHWAY 19 N
Second Line	:
City	:	CAMILLA
State	:	GA
Zip	:	31730-1410
Country	:	US
Telephone Number	:	229-336-1949
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	09/17/2020

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