Healthcare Provider Details

I. General information

NPI: 1205815560
Provider Name (Legal Business Name): CHRISTOPHER JAMES GEORGIANA PA-C, RD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25TH ID, 25TH STB, BAS SCHOFIELD BRKS,
APO AE
96757
US

IV. Provider business mailing address

1011 PENN VIEW LN
DUNCANSVILLE PA
16635-7717
US

V. Phone/Fax

Practice location:
  • Phone: 814-932-0278
  • Fax:
Mailing address:
  • Phone: 814-932-0278
  • Fax: 814-932-0278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberKY1531
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: