Provider Demographics
NPI:1124601075
Name:SCOTT, CHRISTINA MARIE (CERTIFIED NURSES)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CERTIFIED NURSES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 WESLEY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-2328
Mailing Address - Country:US
Mailing Address - Phone:917-312-2368
Mailing Address - Fax:
Practice Address - Street 1:409 WESLEY CLUB DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-2328
Practice Address - Country:US
Practice Address - Phone:917-312-2368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0014203895376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide