Active NPI
Chris S Andersen, M.D.
- Surgery Physician
- Marietta, GA
National Provider Identifier
1255398467
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 030708
- Practice address
- 590 Nancy St NW
Marietta, GA 30060-1334 - Phone
- (770) 423-0395
- Fax
- (770) 499-0352
- NPI assigned
- May 1, 2006
- Last updated
- Dec 3, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 030708 | GA | Primary |
Addresses
Primary practice location
590 Nancy St NW
Marietta, GA 30060-1334
Mailing address
590 Nancy St NW
Marietta, GA 30060-1334
Phone (770) 423-0395
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 898832 | Other | GA | AETNA HMO ID |
| 020046444 | Other | GA | RAILROAD MEDICARE ID |
| 52053446-001 | Other | GA | BC/BS ID |
| 4083355 | Other | GA | AETNA PPO ID |
| 00373183B | Medicaid | GA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | candersen61926@directwellstar.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Interoperability endpoints
- candersen61926@directwellstar.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146441600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575331200000",
"number": "1255398467",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "590 NANCY ST NW",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300601334",
"telephone_number": "770-423-0395",
"fax_number": "770-499-0352"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "590 NANCY ST NW",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300601334",
"telephone_number": "770-423-0395",
"fax_number": "770-499-0352"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSEN",
"first_name": "CHRIS",
"middle_name": "S",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-01",
"last_updated": "2019-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "GA",
"license": "030708",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO ID",
"identifier": "898832",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE ID",
"identifier": "020046444",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS ID",
"identifier": "52053446-001",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PPO ID",
"identifier": "4083355",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00373183B",
"state": "GA"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "candersen61926@directwellstar.org",
"affiliation": "N",
"address_1": "590 Nancy St NW",
"city": "Marietta",
"state": "GA",
"country_code": "US",
"postal_code": "300601334",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.