Provider Demographics
NPI:1396062238
Name:SIKES, CHRISTINA (DO)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:SIKES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 BURLEYSON RD STE 102
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-4600
Mailing Address - Country:US
Mailing Address - Phone:706-272-6596
Mailing Address - Fax:706-272-6270
Practice Address - Street 1:1200 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2529
Practice Address - Country:US
Practice Address - Phone:706-272-6596
Practice Address - Fax:706-272-6270
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA68561207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003127764DMedicaid
GA003127764DMedicaid