Provider Demographics
NPI:1427259829
Name:HARBAUGH, CHRISTINE MARIE (NP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE
Last Name:HARBAUGH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:490 BILL KENNEDY WAY SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-6835
Mailing Address - Country:US
Mailing Address - Phone:404-446-4726
Mailing Address - Fax:404-446-4727
Practice Address - Street 1:490 BILL KENNEDY WAY SE
Practice Address - Street 2:SUITE 101
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-6835
Practice Address - Country:US
Practice Address - Phone:404-446-4726
Practice Address - Fax:404-446-4727
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN125164NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000912909Medicaid