Basic Information
| Provider Information | |||||||||
| NPI: | 1689957276 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | ATC/OTC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 PEACHTREE ROAD NE | ||||||||
| Address2: | SUITE 705 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303090000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043550743 | ||||||||
| FaxNumber: | 4043552136 | ||||||||
| Practice Location | |||||||||
| Address1: | 5505 PEACHTREE DUNWOOD ROAD | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303420000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043550743 | ||||||||
| FaxNumber: | 4043552136 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2011 | ||||||||
| LastUpdateDate: | 05/20/2013 | ||||||||
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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 | 2255A2300X | AT.003748 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 246ZS0410X | 12-1106 | GA | N |
No ID Information.