Provider Demographics
NPI:1790277366
Name:HERRON, CHRISTINA RACKLEY (MS)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:RACKLEY
Last Name:HERRON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:CHRISTINA
Other - Last Name:RACKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:184 US HIGHWAY 319 N
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-9365
Mailing Address - Country:US
Mailing Address - Phone:478-718-4868
Mailing Address - Fax:
Practice Address - Street 1:184 US HIGHWAY 319 N
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-9365
Practice Address - Country:US
Practice Address - Phone:478-718-4868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator