Provider Demographics
NPI:1801886684
Name:HEWITT, CHRISTOPHER DAVID (PA)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:HEWITT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:217 DOZIER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4090
Mailing Address - Country:US
Mailing Address - Phone:843-669-5162
Mailing Address - Fax:843-667-4573
Practice Address - Street 1:555 E CHEVES ST
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2617
Practice Address - Country:US
Practice Address - Phone:843-669-5162
Practice Address - Fax:843-667-4573
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC1059363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Not Answered363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0383PAMedicaid
SCAA1117Medicare UPIN
SCP00273895Medicare ID - Type UnspecifiedMEDICARE RAILROAD
SC0383PAMedicaid