Healthcare Provider Details

I. General information

NPI: 1831157072
Provider Name (Legal Business Name): DONOVAN WAYNE CHRISTIE SR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2227 IDLEWOOD RD
TUCKER GA
30084-4827
US

IV. Provider business mailing address

4514 CHAMBLEE DUNWOODY RD SUITE 328
ATLANTA GA
30338-6202
US

V. Phone/Fax

Practice location:
  • Phone: 678-205-2039
  • Fax: 678-205-2040
Mailing address:
  • Phone: 678-205-2039
  • Fax: 678-205-2040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number044432
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number044432
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: