Basic Information
| Provider Information | |||||||||
| NPI: | 1124048269 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSE | ||||||||
| FirstName: | CHRISTIANA | ||||||||
| MiddleName: | LYNCH | ||||||||
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| Credential: | AU.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7546 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319087546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063247753 | ||||||||
| FaxNumber: | 7063247756 | ||||||||
| Practice Location | |||||||||
| Address1: | 2300 MANCHESTER EXPY | ||||||||
| Address2: | STE C003 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319046877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063247753 | ||||||||
| FaxNumber: | 7063247756 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 07/27/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AUD003644 | GA | Y | Speech, Language and Hearing Service Providers | Audiologist | 231H00000X | 1052A | AL | N | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 003161244 | 05 | GA | MEDICAID | 173717 | 05 | AL | MEDICAID |