Jonathan Logan Chrisian, DMD
Individual provider Active NPI General Practice Dentistry · Vidalia, GA
NPI 1073185336 · NPPES record last updated Aug 10, 2021
Key facts
- NPI
- 1073185336
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DN122426 (GA)
- Practice address
- 311 Pete Phillips Dr
Vidalia, GA 30474-8821 - Phone
- (912) 537-7048
- Fax
- (912) 537-7058
- NPI assigned
- Jul 15, 2021
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN122426 | GA | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN122426 | GA | Yes |
Addresses
Primary practice location
311 Pete Phillips Dr
Vidalia, GA 30474-8821
Mailing address
311 Pete Phillips Dr
Vidalia, GA 30474-8821
Phone (912) 537-7048
Other providers in Vidalia, GA
- Chapman Healthcare Pharmacy Inc
- Chapman Healthcare Pharmacy Inc TLC
- Chapman Healthcare Serv Inc.
- George Wesley Chapman
- Chauncy Montgomery
- Amanda Claire Clark
- Edgar Vincent Clark
- Robert Bicknell Clark Jr.
- Esther Harvey Clements
- Cheryl Taylor Cliff
All providers in Vidalia, GA · General Practice Dentistry in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 10, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.