Provider Demographics
NPI:1588667380
Name:KLIGORA, CHRISTOPHER J (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:J
Last Name:KLIGORA
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 1:311 W 8TH ST NE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-2723
Mailing Address - Country:US
Mailing Address - Phone:706-291-8702
Mailing Address - Fax:
Practice Address - Street 1:311 W 8TH ST NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2723
Practice Address - Country:US
Practice Address - Phone:706-291-8702
Practice Address - Fax:706-291-6514
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055069207ZP0102X, 207ZD0900X
AL00026165207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009986055Medicaid
GA439768538AMedicaid
GA439768538AMedicaid
GA22BDDPBMedicare ID - Type UnspecifiedMEDICARE PROVIDER #
AL009986055Medicaid