Healthcare Provider Details

I. General information

NPI: 1255560009
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL WARD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6713 LUTHER LN
MONROE NC
28112-8500
US

IV. Provider business mailing address

PO BOX 935722
ATLANTA GA
31193-5722
US

V. Phone/Fax

Practice location:
  • Phone: 704-764-5862
  • Fax:
Mailing address:
  • Phone: 843-792-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3909
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: