Provider Demographics
NPI:1558351122
Name:CUNNINGHAM, CHRISTOPHER G (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:G
Last Name:CUNNINGHAM
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 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-3850
Mailing Address - Fax:843-665-8908
Practice Address - Street 1:101 S RAVENEL ST
Practice Address - Street 2:SUITE 230
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2644
Practice Address - Country:US
Practice Address - Phone:843-777-3850
Practice Address - Fax:843-777-7041
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC286932086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC286933Medicaid
NC5906489OtherNC MEDICAID
NC5906489OtherNC MEDICAID
SCAA13228552Medicare PIN