Healthcare Provider Details

I. General information

NPI: 1134545148
Provider Name (Legal Business Name): CHRISTY NELSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 KENNESTONE HOSPITAL BLVD
MARIETTA GA
30060-1120
US

IV. Provider business mailing address

2950 KEARSTIN CT
DOUGLASVILLE GA
30135-6600
US

V. Phone/Fax

Practice location:
  • Phone: 877-354-1821
  • Fax:
Mailing address:
  • Phone: 404-579-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number160608
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0214189
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: