Healthcare Provider Details

I. General information

NPI: 1396062238
Provider Name (Legal Business Name): CHRISTINA SIKES D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MEMORIAL DR
DALTON GA
30720-2529
US

IV. Provider business mailing address

1109 BURLEYSON RD STE 102
DALTON GA
30720-4600
US

V. Phone/Fax

Practice location:
  • Phone: 706-272-6596
  • Fax: 706-272-6270
Mailing address:
  • Phone: 706-272-6596
  • Fax: 706-272-6270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number68561
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: