Healthcare Provider Details

I. General information

NPI: 1558384776
Provider Name (Legal Business Name): CHRISTOPHER ERIC MADISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 WILLIAM HILTON PKWY
HILTON HEAD ISLAND SC
29926-2497
US

IV. Provider business mailing address

460 WILLIAM HILTON PKWY
HILTON HEAD ISLAND SC
29926-2497
US

V. Phone/Fax

Practice location:
  • Phone: 843-738-4800
  • Fax: 843-738-4801
Mailing address:
  • Phone: 843-738-4800
  • Fax: 843-738-4801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30671
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12902
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: