Provider Demographics
NPI:1114944295
Name:ISSA, CHRISTINE E (RD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:E
Last Name:ISSA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 PENINSULA CIR
Mailing Address - Street 2:NUTRITION COUNSELING SERVICES
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-7035
Mailing Address - Country:US
Mailing Address - Phone:770-856-3982
Mailing Address - Fax:
Practice Address - Street 1:220 PENINSULA CIR
Practice Address - Street 2:NUTRITION COUNSELING SERVICES
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-7035
Practice Address - Country:US
Practice Address - Phone:770-856-3982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003429133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered