Healthcare Provider Details

I. General information

NPI: 1043004997
Provider Name (Legal Business Name): CRISTY WEEMS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 COMMERCE BLVD STE A18
RIVERDALE GA
30296-7193
US

IV. Provider business mailing address

804 COMMERCE BLVD STE A18
RIVERDALE GA
30296-7193
US

V. Phone/Fax

Practice location:
  • Phone: 404-316-6434
  • Fax: 855-538-1495
Mailing address:
  • Phone: 404-316-6434
  • Fax: 855-538-1495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP272571
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: