Healthcare Provider Details

I. General information

NPI: 1952111346
Provider Name (Legal Business Name): CHRISTOPHER NETTLES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 WASHINGTON BLVD # 1220
JERSEY CITY NJ
07310-2900
US

IV. Provider business mailing address

613 WASHINGTON BLVD # 1220
JERSEY CITY NJ
07310-2900
US

V. Phone/Fax

Practice location:
  • Phone: 678-367-9537
  • Fax:
Mailing address:
  • Phone: 678-367-9537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL072280000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: