Healthcare Provider Details

I. General information

NPI: 1508732918
Provider Name (Legal Business Name): CHRISTINA A JEET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 MOUNTAIN SPRINGS CV
DALLAS GA
30157-1217
US

IV. Provider business mailing address

31 MOUNTAIN SPRINGS CV
DALLAS GA
30157-1217
US

V. Phone/Fax

Practice location:
  • Phone: 888-635-1022
  • Fax: 833-367-0119
Mailing address:
  • Phone: 888-635-1022
  • Fax: 833-367-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: