Provider Demographics
NPI:1962445841
Name:CHRISTIAN, JOHNNY F (MD)
Entity type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:F
Last Name:CHRISTIAN
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 1:305 JONES AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30830-1510
Mailing Address - Country:US
Mailing Address - Phone:706-554-5147
Mailing Address - Fax:706-554-6111
Practice Address - Street 1:305 JONES AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:GA
Practice Address - Zip Code:30830-1510
Practice Address - Country:US
Practice Address - Phone:706-554-5147
Practice Address - Fax:706-554-6111
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035026207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000478387IMedicaid
GA000478387JMedicaid
GA080142201OtherPALMETTTO GBA RAILROAD
GA000478387DMedicaid
GA080142203OtherPALMETTO GBA RAILROAD
GA080142201OtherPALMETTTO GBA RAILROAD
GAF11124Medicare UPIN