Healthcare Provider Details

I. General information

NPI: 1609813542
Provider Name (Legal Business Name): CHRISTINE MCMAHAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E GREENVILLE ST CANCER CENTER 3RD FLOOR
ANDERSON SC
29621-1580
US

IV. Provider business mailing address

PO BOX 100174
COLUMBIA SC
29202-3174
US

V. Phone/Fax

Practice location:
  • Phone: 864-225-5131
  • Fax: 864-225-2592
Mailing address:
  • Phone: 864-225-5131
  • Fax: 864-225-2592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1209
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberANP1209
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: