Healthcare Provider Details

I. General information

NPI: 1699252387
Provider Name (Legal Business Name): MICHAEL LAUREN CHRISTIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 REFUGE RD
JASPER GA
30143-4934
US

IV. Provider business mailing address

2799 LAWRENCEVILLE HWY STE 106
DECATUR GA
30033-2517
US

V. Phone/Fax

Practice location:
  • Phone: 706-253-4633
  • Fax: 706-253-1192
Mailing address:
  • Phone: 703-753-1154
  • Fax: 470-375-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF07181214
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN221396
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: