Basic Information
| Provider Information | |||||||||
| NPI: | 1205822533 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HULSEY | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | ANDRE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15759 | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314162459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123558188 | ||||||||
| FaxNumber: | 9123566970 | ||||||||
| Practice Location | |||||||||
| Address1: | 4700 WATERS AVE | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314046220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123508436 | ||||||||
| FaxNumber: | 9123566970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2005 | ||||||||
| LastUpdateDate: | 03/30/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 03/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 053246 | GA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | G53246 | 05 | SC | MEDICAID | N343827 | 01 | GA | WELLCARE | OTHER | 108709597B | 05 | GA | MEDICAID | 52703766002 | 01 | GA | BCBS | OTHER | 108709597B | 01 | GA | PEACH STATE HEALTH PLAN | OTHER | P00269230 | 01 | GA | RAILROAD MEDICARE | OTHER |