Healthcare Provider Details

I. General information

NPI: 1093635112
Provider Name (Legal Business Name): CHRISTINE PATRICIA WIEDENHOFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE UNIT 531
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

44 KROG ST NE UNIT 531
ATLANTA GA
30307-2654
US

V. Phone/Fax

Practice location:
  • Phone: 404-686-6044
  • Fax:
Mailing address:
  • Phone: 516-242-8979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN324767
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: