Healthcare Provider Details

I. General information

NPI: 1992826168
Provider Name (Legal Business Name): CHRISTOPHER KIRYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 BAY ST
GADSDEN AL
35901-5108
US

IV. Provider business mailing address

PO BOX 8467
GADSDEN AL
35902-8467
US

V. Phone/Fax

Practice location:
  • Phone: 256-543-0111
  • Fax: 256-543-2907
Mailing address:
  • Phone: 256-546-7765
  • Fax: 256-543-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number8282
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: