Provider Demographics
NPI:1760993760
Name:HUGHSON CHITOLIE, CHARISSE M (FNP)
Entity type:Individual
Prefix:MRS
First Name:CHARISSE
Middle Name:M
Last Name:HUGHSON CHITOLIE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3883 ROGERS BRIDGE RD STE 701
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-2849
Mailing Address - Country:US
Mailing Address - Phone:443-416-8899
Mailing Address - Fax:
Practice Address - Street 1:3883 ROGERS BRIDGE RD STE 701
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-2849
Practice Address - Country:US
Practice Address - Phone:404-381-1178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN146393363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily