Provider Demographics
NPI:1972676625
Name:ROBERTS, CHRISTY CHALEB (PA C)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:CHALEB
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776 DANIEL ELLIS DRIVE
Mailing Address - Street 2:UNIT 1 A
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-3034
Mailing Address - Country:US
Mailing Address - Phone:843-723-6529
Mailing Address - Fax:843-200-0562
Practice Address - Street 1:776 DANIEL ELLIS DRIVE
Practice Address - Street 2:UNIT 1 A
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-3034
Practice Address - Country:US
Practice Address - Phone:843-723-6529
Practice Address - Fax:843-200-0562
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC962363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA06584195Medicare ID - Type Unspecified