Provider Demographics
NPI:1932408440
Name:BREHOB, CRISTINA EVANS (PA-C)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:EVANS
Last Name:BREHOB
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CRISTINA
Other - Middle Name:ANN
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:119 HARMONY XING STE 3
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-9571
Mailing Address - Country:US
Mailing Address - Phone:706-485-4004
Mailing Address - Fax:706-262-2986
Practice Address - Street 1:119 HARMONY XING STE 3
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-9571
Practice Address - Country:US
Practice Address - Phone:706-485-4004
Practice Address - Fax:706-262-2986
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22787363A00000X
ALPA.751363A00000X
GA8685363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051115881OtherBCBS
MS08300026Medicaid
AL128044Medicaid
AL127989Medicaid
AL051115879OtherBCBS
AL128044Medicaid