Healthcare Provider Details

I. General information

NPI: 1811258973
Provider Name (Legal Business Name): CHRISTOPHER NEIL PORT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 TALLULAH RD
ROBBINSVILLE NC
28771-8500
US

IV. Provider business mailing address

PO BOX 100181
COLUMBIA SC
29202-3141
US

V. Phone/Fax

Practice location:
  • Phone: 828-479-6434
  • Fax: 828-479-2674
Mailing address:
  • Phone: 828-202-5200
  • Fax: 828-479-2674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001003411
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: