Provider Demographics
NPI:1215974944
Name:PEREZ, CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:PEREZ
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 1:5578 FARMSIDE WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-6353
Mailing Address - Country:US
Mailing Address - Phone:954-802-8835
Mailing Address - Fax:678-833-1445
Practice Address - Street 1:874 LANIER AVE W STE 220
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7659
Practice Address - Country:US
Practice Address - Phone:678-833-1444
Practice Address - Fax:678-833-1444
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA065875207P00000X, 202K00000X, 2086S0129X, 208D00000X, 208D00000X
FLME80524208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003191533AMedicaid
FL259774800Medicaid
GA003191533AMedicaid
GADE8795Medicare PIN
MOP00889817Medicare UPIN
FLH11761Medicare UPIN
GA202I937824Medicare PIN
MOP00889817Medicare PIN
FL259774800Medicaid
MO152670002Medicare PIN
MOW65000002Medicare PIN
MODF3698Medicare UPIN
GAGRP7227Medicare PIN