Provider Demographics
NPI:1124048269
Name:ROSE, CHRISTIANA LYNCH (AUD)
Entity type:Individual
Prefix:
First Name:CHRISTIANA
Middle Name:LYNCH
Last Name:ROSE
Suffix:
Gender:F
Credentials:AUD
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 7546
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-7546
Mailing Address - Country:US
Mailing Address - Phone:706-324-7753
Mailing Address - Fax:706-324-7756
Practice Address - Street 1:2300 MANCHESTER EXPY
Practice Address - Street 2:STE C003
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6877
Practice Address - Country:US
Practice Address - Phone:706-324-7753
Practice Address - Fax:706-324-7756
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003644231H00000X
AL1052A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003161244Medicaid
AL173717Medicaid