Provider Demographics
NPI:1881658664
Name:THACKER, CHRISTOPHER C (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:C
Last Name:THACKER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:400 BERYWOOD TRL NW
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-5287
Mailing Address - Country:US
Mailing Address - Phone:423-472-3201
Mailing Address - Fax:423-476-4949
Practice Address - Street 1:400 BERYWOOD TRL NW
Practice Address - Street 2:SUITE B
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-5287
Practice Address - Country:US
Practice Address - Phone:423-472-3201
Practice Address - Fax:423-476-4949
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2007-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD34911208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3863228Medicare PIN
H35786Medicare UPIN