Healthcare Provider Details

I. General information

NPI: 1588667380
Provider Name (Legal Business Name): CHRISTOPHER J KLIGORA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W 8TH ST NE
ROME GA
30165-2723
US

IV. Provider business mailing address

311 W 8TH ST NE
ROME GA
30165-2723
US

V. Phone/Fax

Practice location:
  • Phone: 706-291-8702
  • Fax: 706-291-6514
Mailing address:
  • Phone: 706-291-8702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number055069
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number055069
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number00026165
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: