Healthcare Provider Details

I. General information

NPI: 1881123891
Provider Name (Legal Business Name): CHRISTINA ROCHELLE ESCALANTE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11090 SERENBE LN STE 320
PALMETTO GA
30268-2474
US

IV. Provider business mailing address

11090 SERENBE LN STE 320
PALMETTO GA
30268-2474
US

V. Phone/Fax

Practice location:
  • Phone: 470-450-4729
  • Fax: 470-275-0895
Mailing address:
  • Phone: 470-450-4729
  • Fax: 470-275-0895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number89680
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: