Provider Demographics
NPI:1528244159
Name:ANDERSON, CHRISTINE GAYLE (NP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:GAYLE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 SAINT SEBASTIAN WAY
Mailing Address - Street 2:STE 8A
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2643
Mailing Address - Country:US
Mailing Address - Phone:706-722-6900
Mailing Address - Fax:706-722-5118
Practice Address - Street 1:820 SAINT SEBASTIAN WAY
Practice Address - Street 2:SUITE 8A
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2643
Practice Address - Country:US
Practice Address - Phone:706-722-6900
Practice Address - Fax:706-722-5118
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2889363L00000X
GARN139756363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner