Healthcare Provider Details

I. General information

NPI: 1982116331
Provider Name (Legal Business Name): LEE CHRISTOPHER ROSS FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 12/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 NORTH ST
BAMBERG SC
29003-1319
US

IV. Provider business mailing address

3339 CROWELL LN
MOUNT PLEASANT SC
29466-7618
US

V. Phone/Fax

Practice location:
  • Phone: 803-245-2433
  • Fax:
Mailing address:
  • Phone: 843-813-2118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21001
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: