Healthcare Provider Details

I. General information

NPI: 1801880190
Provider Name (Legal Business Name): CHRISTOPHER MAHR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

698 BULTMAN DR SUITE A
SUMTER SC
29150-2549
US

IV. Provider business mailing address

325 BROAD ST SUITE 100
SUMTER SC
29150-4167
US

V. Phone/Fax

Practice location:
  • Phone: 803-773-5227
  • Fax: 803-753-9312
Mailing address:
  • Phone: 803-773-5227
  • Fax: 803-753-9312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28038
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: