MEDICARE: MR. CHRISTOPHER B MERCER P.A.-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	004932	GA
2	363A00000X	Physician Assistant	0010-00833	NC

General Provider Information

NPI Number	:	1619049533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER B MERCER P.A.-C

Provider Business Mailing Address
First Line	:	73 FOREST BY THE SEA ST
Second Line	:
City	:	CAROLINA BEACH
State	:	NC
Zip	:	28428-4721
Country	:	US
Telephone Number	:	910-538-8308
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 SAINT JOSEPH ST APT 73
Second Line	:
City	:	CAROLINA BEACH
State	:	NC
Zip	:	28428-4721
Country	:	US
Telephone Number	:	910-538-8308
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	11/30/2010

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