Healthcare Provider Details

I. General information

NPI: 1245690213
Provider Name (Legal Business Name): CHRISTINA BROOKS LOCKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 WOODMONT LN NW STE 1286
ATLANTA GA
30318-2866
US

IV. Provider business mailing address

7851 GA HIGHWAY 29
SOPERTON GA
30457-5387
US

V. Phone/Fax

Practice location:
  • Phone: 478-697-1691
  • Fax:
Mailing address:
  • Phone: 478-697-1691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberLD004201
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number5089
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD004201
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: