Provider Demographics
NPI:1558305029
Name:NELSON, CHRISTOPHER TODD (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:TODD
Last Name:NELSON
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 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:9100 HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:GRAY COURT
Practice Address - State:SC
Practice Address - Zip Code:29645-4152
Practice Address - Country:US
Practice Address - Phone:864-876-4888
Practice Address - Fax:864-876-4900
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21214207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC080171135OtherRR MEDICARE
SC212148Medicaid
SC7442274OtherAETNA ID
SC212148Medicaid
SCH00010Medicare UPIN