Provider Demographics
NPI:1588628663
Name:WHITTINGTON, CHRISTIAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:A
Last Name:WHITTINGTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:300 SINGLETON RIDGE RD
Mailing Address - Street 2:ATTN PATIENT ACCOUNTING
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9142
Mailing Address - Country:US
Mailing Address - Phone:843-234-6946
Mailing Address - Fax:
Practice Address - Street 1:4300 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-9630
Practice Address - Country:US
Practice Address - Phone:843-399-3377
Practice Address - Fax:843-399-3378
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-28408207Q00000X
CO44051207Q00000X
SC86594207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100366790FMedicaid
CO92677771Medicaid
KS016852105Medicare Oscar/Certification
COC501368Medicare PIN