Basic Information
| Provider Information | |||||||||
| NPI: | 1396788592 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | INHULSEN | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | RODERICK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 MEDICAL COURT | ||||||||
| Address2: | |||||||||
| City: | OGLETHORPE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310680343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4784589942 | ||||||||
| FaxNumber: | 4784589969 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 MEDICAL COURT | ||||||||
| Address2: | |||||||||
| City: | OGLETHORPE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310680343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4784589942 | ||||||||
| FaxNumber: | 4784589969 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 03/23/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20743 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000183235D | 05 | GA | MEDICAID | 00183235 | 05 | GA | MEDICAID |