Provider Demographics
NPI:1407899081
Name:MONTJOY, CHRISTOPHER S (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:S
Last Name:MONTJOY
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 14611
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29610-4611
Mailing Address - Country:US
Mailing Address - Phone:864-306-0966
Mailing Address - Fax:
Practice Address - Street 1:3 ROSEBERRY LN
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-3620
Practice Address - Country:US
Practice Address - Phone:864-306-0966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21498207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC214985Medicaid
SC110233378OtherRR MEDICARE
SCH144237951Medicare PIN
SCH144233640Medicare PIN
SCH14423Medicare UPIN