Healthcare Provider Details

I. General information

NPI: 1396660429
Provider Name (Legal Business Name): CHRISTOPHER GEORGE FENCHAK PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2098 TERON TRCE
DACULA GA
30019-1663
US

IV. Provider business mailing address

2098 TERON TRCE
DACULA GA
30019-1663
US

V. Phone/Fax

Practice location:
  • Phone: 678-722-3940
  • Fax: 678-722-3952
Mailing address:
  • Phone: 678-722-3940
  • Fax: 678-722-3952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberFM2365369
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: