Healthcare Provider Details

I. General information

NPI: 1043638117
Provider Name (Legal Business Name): CHRISTOPHER SHANT HAMAMDJIAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6133 PEACHTREE DUNWOODY RD
ATLANTA GA
30328-5332
US

IV. Provider business mailing address

6133 PEACHTREE DUNWOODY RD
ATLANTA GA
30328-5332
US

V. Phone/Fax

Practice location:
  • Phone: 678-412-0311
  • Fax:
Mailing address:
  • Phone: 678-412-0311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number92233
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: