Provider Demographics
NPI:1295863256
Name:CHRISTIE, JACQUELINE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4514 CHAMBLEE DUNWOODY RD # 328
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6272
Mailing Address - Country:US
Mailing Address - Phone:678-205-2039
Mailing Address - Fax:678-205-2040
Practice Address - Street 1:2227 IDLEWOOD RD
Practice Address - Street 2:SUITE 1
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4827
Practice Address - Country:US
Practice Address - Phone:678-205-2039
Practice Address - Fax:678-205-2040
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2011-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN151674363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner