Provider Demographics
NPI:1124287875
Name:CHRISTENBERRY, DEIRDRE (MD)
Entity type:Individual
Prefix:DR
First Name:DEIRDRE
Middle Name:
Last Name:CHRISTENBERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2923 CAREY CT
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6125
Mailing Address - Country:US
Mailing Address - Phone:706-955-9228
Mailing Address - Fax:
Practice Address - Street 1:2923 CAREY CT
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6125
Practice Address - Country:US
Practice Address - Phone:706-955-9228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-07
Last Update Date:2008-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049280208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice