Provider Demographics
NPI:1104824838
Name:MATHIS, CHRISTOPHER L (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:L
Last Name:MATHIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:DEPT 978
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-821-9990
Mailing Address - Fax:901-821-9991
Practice Address - Street 1:6215 HUMPHREYS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2367
Practice Address - Country:US
Practice Address - Phone:901-821-9990
Practice Address - Fax:901-821-9991
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2017-03-10
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Provider Licenses
StateLicense IDTaxonomies
TN23722208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6012373OtherBCBS
MS00124778Medicaid
AR121811001Medicaid
TN3068083Medicaid
TN3068083Medicaid