Healthcare Provider Details

I. General information

NPI: 1932581329
Provider Name (Legal Business Name): CHRISTINA THALER M.D. PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINA MARIE BRAKKEN-THAL M.D. PH.D.

II. Dates (important events)

Enumeration Date: 06/23/2015
Last Update Date: 07/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EMORY UNIVERSITY HOSPITAL 1364 CLIFTON RD NE
ATLANTA GA
30322-5000
US

IV. Provider business mailing address

EMORY UNIVERSITY HOSPITAL 1364 CLIFTON RD NE
ATLANTA GA
30322-5000
US

V. Phone/Fax

Practice location:
  • Phone: 612-599-8163
  • Fax:
Mailing address:
  • Phone: 612-599-8163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0002X
TaxonomyAdult Congenital Heart Disease Physician
License Number4301504064
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number96245
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207RA0002X
TaxonomyAdult Congenital Heart Disease Physician
License Number96245
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: