Healthcare Provider Details

I. General information

NPI: 1053871772
Provider Name (Legal Business Name): DRAKE CHRISTIAN DEHOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 NORTHSIDE CHEROKEE BLVD
CANTON GA
30115-8015
US

IV. Provider business mailing address

450 NORTHSIDE CHEROKEE BLVD
CANTON GA
30115-8015
US

V. Phone/Fax

Practice location:
  • Phone: 770-224-1000
  • Fax:
Mailing address:
  • Phone: 859-323-9918
  • Fax: 859-323-1197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number92951
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: