Provider Demographics
NPI:1275566937
Name:POWERS, CHRISTOPHER R (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:R
Last Name:POWERS
Suffix:
Gender:M
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:4601 PARK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3239
Mailing Address - Country:US
Mailing Address - Phone:704-323-2000
Mailing Address - Fax:704-945-7681
Practice Address - Street 1:15825 JOHN J DELANEY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3146
Practice Address - Country:US
Practice Address - Phone:704-323-3400
Practice Address - Fax:704-323-3403
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2014-11-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-04880363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-04880OtherNC LICENSE
NCNCI858AMedicare PIN