Provider Demographics
NPI:1720089220
Name:WILTSE, CHRISTI COURAGE (AUD)
Entity type:Individual
Prefix:DR
First Name:CHRISTI
Middle Name:COURAGE
Last Name:WILTSE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1215 EAGLES LANDING PKWY
Mailing Address - Street 2:STE 106
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7279
Mailing Address - Country:US
Mailing Address - Phone:770-507-0384
Mailing Address - Fax:770-507-4629
Practice Address - Street 1:181 UPPER RIVERDALE RD SW
Practice Address - Street 2:STE 1A
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-4919
Practice Address - Country:US
Practice Address - Phone:770-996-2861
Practice Address - Fax:770-991-1604
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3505231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP01990Medicare UPIN
GA64BCBHVMedicare ID - Type Unspecified