Provider Demographics
NPI:1710965207
Name:DAISY, CHRISTOPHER PATRICK (DO)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:PATRICK
Last Name:DAISY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3870
Mailing Address - Country:US
Mailing Address - Phone:800-893-9698
Mailing Address - Fax:
Practice Address - Street 1:745 POPLAR RD
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1618
Practice Address - Country:US
Practice Address - Phone:770-253-1912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA71663207P00000X
MI5101013225207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1710965207Medicaid
CD013225OtherBCBS
MI0158208395OtherBCBS
MI0158208395OtherBCBS
MI1710965207Medicaid
MIN87430015Medicare ID - Type UnspecifiedPEC SJMM (PHYSICIANS)
MIQ26294339Medicare ID - Type UnspecifiedPEC OKW (PHYSICIANS)
P40540018Medicare PIN