Provider Demographics
NPI:1194362889
Name:GAMMAGE, CHRISTAL JOY (DBH, CCRP)
Entity Type:Individual
Prefix:
First Name:CHRISTAL
Middle Name:JOY
Last Name:GAMMAGE
Suffix:
Gender:F
Credentials:DBH, CCRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 POPLAR AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3974
Mailing Address - Country:US
Mailing Address - Phone:901-567-3333
Mailing Address - Fax:
Practice Address - Street 1:6000 POPLAR AVE STE 250
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3974
Practice Address - Country:US
Practice Address - Phone:901-567-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty