Provider Demographics
NPI:1871132324
Name:CHRISTOPHER, JAMES RICHARD JR
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:RICHARD
Last Name:CHRISTOPHER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 BLUE DANUBE DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-4576
Mailing Address - Country:US
Mailing Address - Phone:704-614-8563
Mailing Address - Fax:864-399-6601
Practice Address - Street 1:228 WESTINGHOUSE BLVD STE 111
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-6246
Practice Address - Country:US
Practice Address - Phone:704-614-8563
Practice Address - Fax:864-399-6601
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC008931658172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCLOGISTICAREMedicaid