Healthcare Provider Details

I. General information

NPI: 1750211314
Provider Name (Legal Business Name): MOLLY CHRISTOPHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 ARBOR LANDING DR
MARIETTA GA
30066-2250
US

IV. Provider business mailing address

4315 ARBOR LANDING DR
MARIETTA GA
30066-2250
US

V. Phone/Fax

Practice location:
  • Phone: 404-769-1644
  • Fax: 404-769-1644
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-434522
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: