Healthcare Provider Details

I. General information

NPI: 1700711504
Provider Name (Legal Business Name): CHRISTINA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 JOHNSON FERRY RD STE 148B
MARIETTA GA
30062-6499
US

IV. Provider business mailing address

3238 HIDDEN FOREST CT UNIT 130
MARIETTA GA
30066-3173
US

V. Phone/Fax

Practice location:
  • Phone: 470-444-9774
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT003739
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: