Healthcare Provider Details

I. General information

NPI: 1659768109
Provider Name (Legal Business Name): CHRISTOPHER CAUGHMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WOODRUFF CIR NE SUITE 327
ATLANTA GA
30322-1020
US

IV. Provider business mailing address

2625 HELEN ST
AUGUSTA GA
30904-4621
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-5658
  • Fax:
Mailing address:
  • Phone: 404-271-6717
  • Fax:

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 Code2084N0400X
TaxonomyNeurology Physician
License Number83202
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: