Provider Demographics
NPI:1073680062
Name:KOLASA, CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:KOLASA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15238
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-1938
Mailing Address - Country:US
Mailing Address - Phone:912-354-4813
Mailing Address - Fax:912-650-5488
Practice Address - Street 1:3025 SHRINE RD STE 450
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4787
Practice Address - Country:US
Practice Address - Phone:912-264-6133
Practice Address - Fax:912-267-1415
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA102416207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6548601Medicaid
NJ6548601Medicaid