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General NPI Number Information
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NPI Number | 1629788336
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Entity Type | Individual
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Provider Name | CHRISTIAN PODACA RN
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Gender | Male
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Dates
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Enumeration Date | 12/05/2022
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 595 HURRICANE SHOALS RD NW STE 100
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8762
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Country | US
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Telephone | 404-645-7150
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Fax | 404-645-7177
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Provider Business Mailing Address
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Address Line | 4204 PEACHFORD CIR
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City | DUNWOODY
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State | GA
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Zip | 30338-6490
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WH0500X
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Taxonomy Name | Hemodialysis Registered Nurse
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License Number | RN280762
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2024089462
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License Number State | GA
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