Healthcare Provider Details

I. General information

NPI: 1912035023
Provider Name (Legal Business Name): CHRISTINE LYNN IRWIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 WINN WAY
DECATUR GA
30030-1715
US

IV. Provider business mailing address

3782 LANCE BLUFF LN
DULUTH GA
30097-7377
US

V. Phone/Fax

Practice location:
  • Phone: 404-294-0499
  • Fax: 404-294-0793
Mailing address:
  • Phone: 770-476-5097
  • Fax: 770-476-5097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN120987
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: