Provider Demographics
NPI:1770814253
Name:NELSON, CHRISTOPHER G (MT(ASCP))
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:G
Last Name:NELSON
Suffix:
Gender:M
Credentials:MT(ASCP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 WIMBLEDON DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-8873
Mailing Address - Country:US
Mailing Address - Phone:704-674-8995
Mailing Address - Fax:
Practice Address - Street 1:29 BLACK COAL RD
Practice Address - Street 2:
Practice Address - City:FT. WASHAKIE
Practice Address - State:WY
Practice Address - Zip Code:82514
Practice Address - Country:US
Practice Address - Phone:307-332-7692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ASCP 194603246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist