=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033431093
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTIE CHEEYOUNG OH LO GNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2010
-----------------------------------------------------
Last Update Date | 02/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5579 MABLETON PKWY SW
-----------------------------------------------------
City | MABLETON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30126-3301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-948-1049
-----------------------------------------------------
Fax | 770-944-7861
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5579 MABLETON PKWY SW
-----------------------------------------------------
City | MABLETON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30126-3301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-948-1049
-----------------------------------------------------
Fax | 770-944-7861
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | RN188876 NP
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------