1134404072 NPI number — CHRISTY A FLOYD R.N., CPNP-PC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134404072 NPI number — CHRISTY A FLOYD R.N., CPNP-PC

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

FLOYD

Provider First Name:

CHRISTY

Provider Middle Name:

A

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

R.N., CPNP-PC

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1134404072

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

08/17/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 658

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

GAINESVILLE

Provider Business Mailing Address State Name:

GA

Provider Business Mailing Address Postal Code:

30503-0658

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

770-718-1122

Provider Business Mailing Address Fax Number:

770-533-4786

Provider First Line Business Practice Location Address:

155 PROFESSIONAL DR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BALDWIN

Provider Business Practice Location Address State Name:

GA

Provider Business Practice Location Address Postal Code:

30511-4000

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

706-776-2368

Provider Business Practice Location Address Fax Number:

706-776-2589

Provider Enumeration Date:

10/11/2011

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 363LP0200X , with the licence number:  RN080953 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 003116882B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1707077 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 1773745 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 1773751 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 1773752 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 003116882F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 06210110 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 1773747 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 290720346A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 003116882E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 003116882C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 003116882D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".