Provider Demographics
NPI:1376651026
Name:ANDERSON, CHRISTOPHER J (NP)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MOHAWK ST STE E
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1768
Mailing Address - Country:US
Mailing Address - Phone:912-925-0067
Mailing Address - Fax:912-927-0267
Practice Address - Street 1:900 MOHAWK ST STE E
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1768
Practice Address - Country:US
Practice Address - Phone:912-925-0067
Practice Address - Fax:912-927-0267
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN2728207N00000X, 207NP0225X, 207NS0135X, 363LA2200X
GARN105862207NP0225X, 207NS0135X, 363LA2200X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA837663219BMedicaid
GA837663219AMedicaid
GA837663219CMedicaid
SCNP0945Medicaid
GA837663219DMedicaid
SCP957908312Medicare ID - Type UnspecifiedSOUTH CAROLINA MEDICAID
GA837663219BMedicaid
GA837663219AMedicaid
GA50BBGXJMedicare ID - Type UnspecifiedMEDICARE NUMBER
SCNP0945Medicaid