Healthcare Provider Details

I. General information

NPI: 1164429825
Provider Name (Legal Business Name): TOM A CHRISTENSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 SEA MOUNTAIN HIGWAY SUITE C
LITTLE RIVER SC
29566
US

IV. Provider business mailing address

AGAPE SENIOR PRIMARY CARE INC DBA MAIN STREET PHYSICIAN 1624 MAIN STREET
COLUMBIA SC
29201-2818
US

V. Phone/Fax

Practice location:
  • Phone: 843-399-4848
  • Fax: 910-653-2346
Mailing address:
  • Phone: 803-726-2350
  • Fax: 803-753-9102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18363
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: