MEDICARE: CHRISTIAN HAROLD PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	9346	GA
2	363A00000X	Physician Assistant	0010-05351	NC

General Provider Information

NPI Number	:	1851799878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN HAROLD PA-C

Provider Business Mailing Address
First Line	:	1968 PEACHTREE RD NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1285
Country	:	US
Telephone Number	:	404-367-3014
Fax Number	:

Provider Business Practice Location Address
First Line	:	1968 PEACHTREE RD NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1285
Country	:	US
Telephone Number	:	404-367-3014
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2014
Last Update Date	:	11/18/2019

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Directions to “ CHRISTIAN HAROLD PA-C” Practice Location

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