Healthcare Provider Details

I. General information

NPI: 1427056647
Provider Name (Legal Business Name): CHRISTOPHER L MCLENDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 RIVERSIDE PARK BLVD
MACON GA
31210-1365
US

IV. Provider business mailing address

4030 RIVERSIDE PARK BLVD
MACON GA
31210-1365
US

V. Phone/Fax

Practice location:
  • Phone: 478-474-2200
  • Fax: 478-314-0740
Mailing address:
  • Phone: 478-474-2200
  • Fax: 478-314-0740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number031627
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: