Provider Demographics
NPI:1407203235
Name:TICE, CHRISTINA (CNM)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:TICE
Suffix:
Gender:F
Credentials:CNM
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Other - First Name:
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Mailing Address - Street 1:5780 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1554
Mailing Address - Country:US
Mailing Address - Phone:404-303-1224
Mailing Address - Fax:404-303-1325
Practice Address - Street 1:11 DUNWOODY PARK
Practice Address - Street 2:SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-7408
Practice Address - Country:US
Practice Address - Phone:770-730-0451
Practice Address - Fax:770-730-0141
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN109252367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife