Provider Demographics
NPI:1306264601
Name:CASTATER, CHRISTINE AISHA (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:AISHA
Last Name:CASTATER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AISHA
Other - Middle Name:CHRISTINE
Other - Last Name:CASTATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:55 WHITCHER ST NE STE 130
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1156
Mailing Address - Country:US
Mailing Address - Phone:770-428-0462
Mailing Address - Fax:770-427-8001
Practice Address - Street 1:55 WHITCHER ST NE STE 130
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1156
Practice Address - Country:US
Practice Address - Phone:770-428-0462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA81979208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program