Provider Demographics
NPI:1891083945
Name:YOUNGBLOOD, CHRISTINE MARIE (HIS)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MARIE
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 NORTHSIDE DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1871
Mailing Address - Country:US
Mailing Address - Phone:229-244-3999
Mailing Address - Fax:229-244-4366
Practice Address - Street 1:401 NORTHSIDE DR
Practice Address - Street 2:SUITE E
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1871
Practice Address - Country:US
Practice Address - Phone:229-244-3999
Practice Address - Fax:229-244-4366
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS000767237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist