Provider Demographics
NPI:1194762625
Name:EDENS, CHRISTOPHER ALTON (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ALTON
Last Name:EDENS
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 1:2011 COMMERCE DR N STE 25
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3538
Mailing Address - Country:US
Mailing Address - Phone:844-994-6633
Mailing Address - Fax:470-235-1861
Practice Address - Street 1:2011 COMMERCE DR N STE 25
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3538
Practice Address - Country:US
Practice Address - Phone:478-542-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA42042208D00000X
GA042042207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA002023289OtherUNITED HEALTHCARE MPIN
GA000757182KMedicaid
GA000757182KMedicaid
GA93BFBSQMedicare ID - Type Unspecified