1750390936 NPI number — CHRISTOPHER J LINBERG MD

Table of content: CHRISTOPHER J LINBERG MD (NPI 1750390936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750390936 NPI number — CHRISTOPHER J LINBERG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINBERG
Provider First Name:
CHRISTOPHER
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1750390936
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1270 FRIENDSHIP RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRASELTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30517-5630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-207-4477
Provider Business Practice Location Address Fax Number:
678-207-4478
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  ME104686 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 90335 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500098100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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