Provider Demographics
NPI:1053316943
Name:DAVIS, CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 FOUNDRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHERAW
Mailing Address - State:SC
Mailing Address - Zip Code:29520-2500
Mailing Address - Country:US
Mailing Address - Phone:877-848-1463
Mailing Address - Fax:
Practice Address - Street 1:34 FOUNDRY HILL RD
Practice Address - Street 2:
Practice Address - City:CHERAW
Practice Address - State:SC
Practice Address - Zip Code:29520-2500
Practice Address - Country:US
Practice Address - Phone:877-848-1463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17273207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890065YNMedicaid
SC172734Medicaid
SC184433OtherUNISON
SC20019649OtherSELECT HEALTH
SCF877005063Medicare PIN
SC184433OtherUNISON
SC080152105Medicare PIN
SC172734Medicaid
NC890065YNMedicaid
SCF877006243Medicare PIN