Provider Demographics
NPI:1619902392
Name:BURCH, CHRISTINA M (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:BURCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5416 BRICK CHURCH PIKE
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-9016
Mailing Address - Country:US
Mailing Address - Phone:615-855-0594
Mailing Address - Fax:
Practice Address - Street 1:5416 BRICK CHURCH PIKE
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-9016
Practice Address - Country:US
Practice Address - Phone:615-855-0594
Practice Address - Fax:615-851-2017
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35701174400000X, 2084N0400X
FLME01140432084N0008X
IN01072058A2084N0400X
ALMD.314582084N0400X
CAC554052084N0400X
AZMD452722084N0400X
IA419792084N0400X
KY468082084N0400X
GA11040790702084N0400X
IL0361293632084N0400X
PAMD040189L2084N0400X
MS24062084N0400X
MI43015035412084N0400X
WI63038-202084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialist
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025202450001Medicaid
TN3842541Medicaid
TNF19812Medicare UPIN
TN3842541Medicaid