Provider Demographics
NPI:1407882582
Name:WIXON, CHRISTOPHER L (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:L
Last Name:WIXON
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:PO BOX 116336
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-6336
Mailing Address - Country:US
Mailing Address - Phone:912-352-8346
Mailing Address - Fax:912-355-1414
Practice Address - Street 1:111 PERSIMMONS ST
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4779
Practice Address - Country:US
Practice Address - Phone:912-629-7800
Practice Address - Fax:912-355-1414
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0491222086S0129X
SC221962086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10065827OtherAMERIGROUP
SCG49122Medicaid
GA349840OtherWELLCARE OF GA
GA000880569BMedicaid
SCG49122Medicaid
SC582162071-008OtherBCBS SC (4750 WATERS AVE)
GA10065827OtherAMERIGROUP
GA770002854Medicare PIN
SCP00716584Medicare PIN
SCH314909126Medicare PIN
SC582162071-008OtherBCBS SC (4750 WATERS AVE)
GA349840OtherWELLCARE OF GA
SC582162071-032OtherBCBS SC (7 MALLETT WAY)
GA000880569BMedicaid
SCH314907416Medicare PIN