Healthcare Provider Details

I. General information

NPI: 1609076140
Provider Name (Legal Business Name): CHRISTOPHER CHAD KORNEGAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521B MOYE BLVD. 2ND FLOOR ECU PHYSICIANS MOYE MEDICAL CENTER
GREENVILLE NC
27834
US

IV. Provider business mailing address

521B MOYE BLVD. 2ND FLOOR ECU PHYSICIANS MOYE MEDICAL CENTER
GREENVILLE NC
27834
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-3229
  • Fax: 252-744-3924
Mailing address:
  • Phone: 252-744-3229
  • Fax: 252-744-3924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2008-00655
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: