=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205815560
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTOPHER JAMES GEORGIANA PA-C, RD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2006
-----------------------------------------------------
Last Update Date | 12/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25TH ID, 25TH STB, BAS SCHOFIELD BRKS,
-----------------------------------------------------
City | APO
-----------------------------------------------------
State | AE
-----------------------------------------------------
Zip | 96757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-932-0278
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1011 PENN VIEW LN
-----------------------------------------------------
City | DUNCANSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16635-7717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-932-0278
-----------------------------------------------------
Fax | 814-932-0278
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | KY1531
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------