Provider Demographics
NPI:1982023339
Name:EDENFIELD, CHRISTOPHER JAMES (PA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JAMES
Last Name:EDENFIELD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1938 CHARLIE HALL BLVD UNIT B
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-6099
Mailing Address - Country:US
Mailing Address - Phone:843-402-0227
Mailing Address - Fax:843-402-0232
Practice Address - Street 1:1938 CHARLIE HALL BLVD UNIT B
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-6099
Practice Address - Country:US
Practice Address - Phone:843-402-0227
Practice Address - Fax:843-402-0232
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2100363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1851PAMedicaid
SCSC30535019Medicare PIN