Healthcare Provider Details

I. General information

NPI: 1629715610
Provider Name (Legal Business Name): CHRISTOPHER O'MARA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E HOSPITAL RD
FORT GORDON GA
30905
US

IV. Provider business mailing address

3208 WEST CT
AUGUSTA GA
30907-3802
US

V. Phone/Fax

Practice location:
  • Phone: 508-802-0560
  • Fax:
Mailing address:
  • Phone: 508-802-0560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0073314
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: