Provider Demographics
NPI:1902805450
Name:KUETTNER, CHRISTOPHER AMADEUS (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:AMADEUS
Last Name:KUETTNER
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 1:836 E. 65TH STREET
Mailing Address - Street 2:SUITE 22
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:912-819-7878
Mailing Address - Fax:912-819-3320
Practice Address - Street 1:600 E. OGLETHORPE HY
Practice Address - Street 2:SUITE B
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313
Practice Address - Country:US
Practice Address - Phone:912-756-3872
Practice Address - Fax:912-756-5355
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024008207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA019610OtherBC/BS OF GA
GA110006848OtherRAILROAD MEDICARE
GA110006848OtherRAILROAD MEDICARE
D70518Medicare UPIN