Healthcare Provider Details

I. General information

NPI: 1003854373
Provider Name (Legal Business Name): CHRISTINE M LOCKHART CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 US HIGHWAY 19 N
CAMILLA GA
31730-1410
US

IV. Provider business mailing address

920 CAIRO RD
THOMASVILLE GA
31792-4255
US

V. Phone/Fax

Practice location:
  • Phone: 229-336-1949
  • Fax:
Mailing address:
  • Phone: 229-227-5500
  • Fax: 229-227-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR125749
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: