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General NPI Number Information
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NPI Number | 1295863256
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Entity Type | Individual
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Provider Name | JACQUELINE CHRISTIE APRN
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Gender | Female
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 10/08/2011
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Provider Practice Location Address
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Address Line | 2227 IDLEWOOD RD SUITE 1
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City | TUCKER
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State | GA
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Zip | 30084-4827
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Country | US
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Telephone | 678-205-2039
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Fax | 678-205-2040
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Provider Business Mailing Address
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Address Line | 4514 CHAMBLEE DUNWOODY RD # 328
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City | ATLANTA
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State | GA
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Zip | 30338-6272
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Country | US
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Telephone | 678-205-2039
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Fax | 678-205-2040
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN151674
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License Number State | GA
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