Provider Information for 1215560545
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CHINNIKA LATRICE CRISLER
Sex: Female
NPI: 1215560545
Last Updated: 2025-02-03
Certification Date: 2025-02-03
Certification Date: 2025-02-03
Details
| Name | Value | ||||||||||||||||||||||||||||
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| NPI | 1215560545 | ||||||||||||||||||||||||||||
| Enumeration Date | 2020-02-14 | ||||||||||||||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||||||||||||||
| Status | Active | ||||||||||||||||||||||||||||
| Mailing Address | PO BOX 746085 ATLANTA, GA 30374-6085 United States Phone: 469-727-6675 | Fax: | ||||||||||||||||||||||||||||
| Primary Practice Address | 4541 N STATE ST JACKSON, MS 39206-5308 United States Phone: 601-533-7017 | Fax: | ||||||||||||||||||||||||||||
| Secondary Practice Address(es) | 1134 WINTER ST | ||||||||||||||||||||||||||||
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