Provider Demographics
NPI:1699477612
Name:JUSON, CHRISTIAN DELA ROSA
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:DELA ROSA
Last Name:JUSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 DULUTH HWY STE 501
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8709
Mailing Address - Country:US
Mailing Address - Phone:678-312-4072
Mailing Address - Fax:
Practice Address - Street 1:665 DULUTH HWY STE 501
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8709
Practice Address - Country:US
Practice Address - Phone:678-312-4072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program