Provider Demographics
NPI:1689957276
Name:DAVIS, CHRISTINE M (ATC/OTC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:ATC/OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 PEACHTREE ROAD NE
Mailing Address - Street 2:SUITE 705
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-0000
Mailing Address - Country:US
Mailing Address - Phone:404-355-0743
Mailing Address - Fax:404-355-2136
Practice Address - Street 1:5505 PEACHTREE DUNWOOD ROAD
Practice Address - Street 2:SUITE 600
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-0000
Practice Address - Country:US
Practice Address - Phone:404-355-0743
Practice Address - Fax:404-355-2136
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0037482255A2300X
GA12-1106246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0225920002Medicare NSC