Provider Demographics
NPI:1114149713
Name:GILES, CHRISTINE EVETTE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:EVETTE
Last Name:GILES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 LUCERNE LN SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-4529
Mailing Address - Country:US
Mailing Address - Phone:850-284-8560
Mailing Address - Fax:
Practice Address - Street 1:2386 CLOWER ST
Practice Address - Street 2:BUILDING E SUITE 102
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6134
Practice Address - Country:US
Practice Address - Phone:770-985-9050
Practice Address - Fax:770-985-9223
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004956235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist