Provider Demographics
NPI:1912078676
Name:RARY, CHRISTIE (RPT)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:RARY
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:ELWELL
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:581 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2210
Mailing Address - Country:US
Mailing Address - Phone:404-395-4228
Mailing Address - Fax:
Practice Address - Street 1:581 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2210
Practice Address - Country:US
Practice Address - Phone:404-395-4228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007792174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA966327739AMedicaid