Provider Demographics
NPI:1124808001
Name:WEST, CHRISTOPHER SPENCER (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:SPENCER
Last Name:WEST
Suffix:
Gender:
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4850 KINGS WOOD DR NE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4009
Mailing Address - Country:US
Mailing Address - Phone:678-708-7306
Mailing Address - Fax:
Practice Address - Street 1:1240 JESSE JEWELL PKWY SE STE 300
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3861
Practice Address - Country:US
Practice Address - Phone:770-532-7202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11914363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant