Healthcare Provider Details

I. General information

NPI: 1588628663
Provider Name (Legal Business Name): CHRISTIAN A. WHITTINGTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 HIGHWAY 90
CONWAY SC
29526-9630
US

IV. Provider business mailing address

300 SINGLETON RIDGE RD ATTN PATIENT ACCOUNTING
CONWAY SC
29526-9142
US

V. Phone/Fax

Practice location:
  • Phone: 843-399-3377
  • Fax: 843-399-3378
Mailing address:
  • Phone: 843-234-6946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-28408
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number44051
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number86594
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: