Provider Demographics
NPI:1023095361
Name:CORNOR, CHRISTOPHER C (CRNA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:C
Last Name:CORNOR
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 NORTH WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150
Mailing Address - Country:US
Mailing Address - Phone:803-774-8726
Mailing Address - Fax:803-774-9846
Practice Address - Street 1:1315 ROBERTS STREET
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020
Practice Address - Country:US
Practice Address - Phone:803-432-4311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2022-02-03
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-09-11
Provider Licenses
StateLicense IDTaxonomies
SC1851367500000X
SCR66014367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00054273OtherMEDICARE RR ID#
SCAN1221Medicaid
SCQ33315Medicare UPIN
SCAN1221Medicaid