Healthcare Provider Details

I. General information

NPI: 1306751557
Provider Name (Legal Business Name): CHRISTOPHER MUTUA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1894 LUDOVIE LN
DECATUR GA
30033-1044
US

IV. Provider business mailing address

1894 LUDOVIE LN
DECATUR GA
30033-1044
US

V. Phone/Fax

Practice location:
  • Phone: 678-626-0557
  • Fax: 678-288-7932
Mailing address:
  • Phone: 678-626-0557
  • Fax: 678-288-7932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number26526245
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: