Provider Demographics
NPI:1871263384
Name:CHARLEY, KHRISTINA JEROME (RN)
Entity Type:Individual
Prefix:
First Name:KHRISTINA
Middle Name:JEROME
Last Name:CHARLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 HAMMOND DR APT 2408
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5568
Mailing Address - Country:US
Mailing Address - Phone:404-326-9220
Mailing Address - Fax:
Practice Address - Street 1:795 HAMMOND DR APT 2408
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5568
Practice Address - Country:US
Practice Address - Phone:404-326-9220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN298361163WX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0800XNursing Service ProvidersRegistered NurseOrthopedic