Healthcare Provider Details

I. General information

NPI: 1801150735
Provider Name (Legal Business Name): CHRISTY CUNNINGHAM D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 NATURAL RESOURCES DR
LITTLE ROCK AR
72205-1539
US

IV. Provider business mailing address

1120 15TH ST
AUGUSTA GA
30912-0004
US

V. Phone/Fax

Practice location:
  • Phone: 678-469-2386
  • Fax:
Mailing address:
  • Phone: 678-469-2386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberE-9884
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: