Provider Demographics
NPI:1073603411
Name:BURRESS, CHRISTOPHER SHEA (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:SHEA
Last Name:BURRESS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10044 HIGHWAY 46
Mailing Address - Street 2:
Mailing Address - City:BON AQUA
Mailing Address - State:TN
Mailing Address - Zip Code:37025-1764
Mailing Address - Country:US
Mailing Address - Phone:931-996-4247
Mailing Address - Fax:931-996-4248
Practice Address - Street 1:10044 HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:BON AQUA
Practice Address - State:TN
Practice Address - Zip Code:37025-1764
Practice Address - Country:US
Practice Address - Phone:931-996-4247
Practice Address - Fax:931-996-4248
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO-2027207RH0002X, 2083P0901X, 204D00000X, 207R00000X, 208M00000X
TNDO2027208000000X, 207R00000X
ALDO-941208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1522546Medicaid
TN11777708OtherCAQH