Provider Demographics
NPI:1013742790
Name:SPITALE, CHRISTOPHER JAMES (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JAMES
Last Name:SPITALE
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 N COLUMBIA AVE STE D
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-6808
Mailing Address - Country:US
Mailing Address - Phone:912-527-1120
Mailing Address - Fax:912-295-5817
Practice Address - Street 1:214 N COLUMBIA AVE STE D
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-6808
Practice Address - Country:US
Practice Address - Phone:912-596-8874
Practice Address - Fax:912-295-5817
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN265824363LP0808X
GA2024066877363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health