Provider Demographics
NPI:1669873113
Name:CHRISTOPHER S. BURRESS, MD
Entity type:Organization
Organization Name:CHRISTOPHER S. BURRESS, MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:S
Authorized Official - Last Name:BURRESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-996-4247
Mailing Address - Street 1:10044 HIGHWAY 46
Mailing Address - Street 2:
Mailing Address - City:BON AQUA
Mailing Address - State:TN
Mailing Address - Zip Code:37025-1764
Mailing Address - Country:US
Mailing Address - Phone:931-996-4247
Mailing Address - Fax:931-996-4248
Practice Address - Street 1:10044 HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:BON AQUA
Practice Address - State:TN
Practice Address - Zip Code:37025-1764
Practice Address - Country:US
Practice Address - Phone:931-996-4247
Practice Address - Fax:931-996-4248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-15
Last Update Date:2018-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1522546Medicaid
TN11777708OtherCAQH
AL1073603411OtherINDIVIDUAL NPI