Provider Demographics
NPI:1710584529
Name:AMADI, CHRISTOPHER AMADI
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER AMADI
Middle Name:
Last Name:AMADI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 SIX FORKS RD STE OFFIC478
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-5276
Mailing Address - Country:US
Mailing Address - Phone:919-623-8016
Mailing Address - Fax:
Practice Address - Street 1:8601 SIX FORKS RD STE 47886016
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5276
Practice Address - Country:US
Practice Address - Phone:919-623-8016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC5652251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHC5652Medicaid