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General NPI Number Information
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NPI Number | 1912078676
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Entity Type | Individual
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Provider Name | CHRISTIE RARY RPT
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Gender | Female
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 09/28/2011
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Provider Practice Location Address
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Address Line | 581 VIRGINIA AVE
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City | SUWANEE
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State | GA
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Zip | 30024-2210
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Country | US
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Telephone | 404-395-4228
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Fax |
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Provider Business Mailing Address
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Address Line | 581 VIRGINIA AVE
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City | SUWANEE
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State | GA
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Zip | 30024-2210
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Country | US
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Telephone | 404-395-4228
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Fax |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | PT007792
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License Number State | GA
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