MEDICARE: DR. CHRISTOPHER C. JERNIGAN D.M.D.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	3709	SC

General Provider Information

NPI Number	:	1811059678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER C. JERNIGAN D.M.D.

Provider Business Mailing Address
First Line	:	5 LAKE CAROLINA BLVD STE 250
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-7563
Country	:	US
Telephone Number	:	803-736-0065
Fax Number	:	803-736-6464

Provider Business Practice Location Address
First Line	:	5 LAKE CAROLINA BLVD STE 250
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-7563
Country	:	US
Telephone Number	:	803-736-0065
Fax Number	:	803-736-6464

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

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	07/08/2007

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