Provider Demographics
NPI:1700229960
Name:BABSON, CHRISTIE LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIE
Middle Name:LYNN
Last Name:BABSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-0567
Mailing Address - Fax:704-384-0568
Practice Address - Street 1:1718 E 4TH ST STE 601
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3263
Practice Address - Country:US
Practice Address - Phone:704-384-0567
Practice Address - Fax:704-384-0568
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP03280208000000X
63289390200000X
NC1123296208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1700229960Medicaid