Healthcare Provider Details

I. General information

NPI: 1497011084
Provider Name (Legal Business Name): CHRISTOPHER J DUDLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2012
Last Update Date: 02/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 JESSE HILL JR DR SE DEPARTMENT OF EMERGENCY MEDICINE, STEINER BUILDING
ATLANTA GA
30303-3049
US

IV. Provider business mailing address

49 JESSE HILL JR DR SE DEPARTMENT OF EMERGENCY MEDICINE, STEINER BUILDING
ATLANTA GA
30303-3049
US

V. Phone/Fax

Practice location:
  • Phone: 404-251-8850
  • Fax: 404-688-6355
Mailing address:
  • Phone: 404-251-8850
  • Fax: 404-688-6355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number073104
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: