Provider Demographics
NPI:1922233808
Name:JAILLET, CHRISTY F (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:F
Last Name:JAILLET
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:E
Other - Last Name:FOREMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3005 OLD ALABAMA RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8594
Mailing Address - Country:US
Mailing Address - Phone:678-393-9445
Mailing Address - Fax:
Practice Address - Street 1:3005 OLD ALABAMA RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-8594
Practice Address - Country:US
Practice Address - Phone:678-230-3846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001864152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist