Basic Information
| Provider Information | |||||||||
| NPI: | 1396982559 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ESTABROOK | ||||||||
| FirstName: | CHRISTINE | ||||||||
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| Credential: | ANP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1506 KLONDIKE RD SW | ||||||||
| Address2: | 203 | ||||||||
| City: | CONYERS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300945173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707617260 | ||||||||
| FaxNumber: | 6784131818 | ||||||||
| Practice Location | |||||||||
| Address1: | 1506 KLONDIKE RD SW | ||||||||
| Address2: | 203 | ||||||||
| City: | CONYERS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300945173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707617260 | ||||||||
| FaxNumber: | 6784131818 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2009 | ||||||||
| LastUpdateDate: | 03/18/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 185062 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.