Healthcare Provider Details

I. General information

NPI: 1679632632
Provider Name (Legal Business Name): CHRISTELLE ALVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 WINDY HILL RD SE SUITE 204
MARIETTA GA
30067-8664
US

IV. Provider business mailing address

PO BOX 673035
MARIETTA GA
30006-0051
US

V. Phone/Fax

Practice location:
  • Phone: 770-955-7746
  • Fax:
Mailing address:
  • Phone: 770-955-7746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: