Provider Demographics
NPI:1477666501
Name:STEPHENSON, CHRISTOPHER GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:GEORGE
Last Name:STEPHENSON
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 1:7825 BALLANTYNE COMMONS PKWY
Mailing Address - Street 2:SUITE 360
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3174
Mailing Address - Country:US
Mailing Address - Phone:704-989-3471
Mailing Address - Fax:704-989-3471
Practice Address - Street 1:7825 BALLANTYNE COMMONS PKWY
Practice Address - Street 2:SUITE 360
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3174
Practice Address - Country:US
Practice Address - Phone:704-989-3471
Practice Address - Fax:704-989-3471
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300531207R00000X, 207RC0000X
SC27002207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1336KOtherBCBS
NC891336KMedicaid
P00201615OtherRAILROAD MEDICARE
SCN00534Medicaid
SCN00534Medicaid
NC1336KOtherBCBS
NC2015879AMedicare PIN
SCH841748186Medicare PIN