1467455949 NPI number — DON R CHRISTIAN JR. MD

Table of content: DON R CHRISTIAN JR. MD (NPI 1467455949)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467455949 NPI number — DON R CHRISTIAN JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHRISTIAN
Provider First Name:
DON
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467455949
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2295 HENRY TECKLENBERG DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29414-7801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-766-7103
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1231 RIBAUT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAUFORT
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29902-6147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-525-6622
Provider Business Practice Location Address Fax Number:
843-522-8243
Provider Enumeration Date:
05/27/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  22862 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7326369 . This is a "AETNA DON R CHRISTIAN PIN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 228621 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7215359 . This is a "AETNA GROUP PIN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 1265654511 . This is a "GROUP BFTENT NPI" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: GP3955 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00158816 . This is a "RR MEDICARE PIN #" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".