Provider Demographics
NPI:1376294330
Name:WITTER, CHRISTINE WILSON (FNP-C)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:WILSON
Last Name:WITTER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:WILSON
Other - Last Name:WITTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:3758 SEPTEMBER WAY
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-8042
Mailing Address - Country:US
Mailing Address - Phone:404-940-3504
Mailing Address - Fax:
Practice Address - Street 1:311 GWINNETT DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-5671
Practice Address - Country:US
Practice Address - Phone:404-940-3504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN229253363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner