| Doctor Name: | CHRISTOPHER DAVID FONTIMAYOR |
| NPI Number: | 1750618617 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 6571 |
| Business Practice Address: | 4114 Mansfield Pl Martinez, GA - 309072675 |
| Business Phone Number: | 7068142409 |
| Business Fax Number: | |
| Mailing Address: | 1586 Lenox Overlook Rd Ne, ATLANTA |
| State: | GA |
| Postal Code: | 303291528 |
| Phone Number: | 7068142409 |
| Fax Number: | |
| NPI Enumeration Date: | 11/12/2009 |
| NPI Last Update Date: | 06/25/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | 6571 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | GA |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |