Provider Demographics
NPI:1558925248
Name:LOCKE, CHRISTINA JOAN (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JOAN
Last Name:LOCKE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:STE A500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-7162
Mailing Address - Country:US
Mailing Address - Phone:678-781-7373
Mailing Address - Fax:678-538-1972
Practice Address - Street 1:5995 BARFIELD RD
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-4411
Practice Address - Country:US
Practice Address - Phone:404-256-1507
Practice Address - Fax:404-256-1981
Is Sole Proprietor?:No
Enumeration Date:2019-04-28
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH006754152W00000X
390200000X
GAOPT003235152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program