Provider Demographics
NPI:1154048460
Name:JOSEPH, CHRISTANE G (PMHNP)
Entity type:Individual
Prefix:
First Name:CHRISTANE
Middle Name:G
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 ANDERSON MILL RD APT 5108
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1270
Mailing Address - Country:US
Mailing Address - Phone:561-271-0702
Mailing Address - Fax:
Practice Address - Street 1:1650 ANDERSON MILL RD APT 5108
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1270
Practice Address - Country:US
Practice Address - Phone:561-271-0702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9317226363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health