Healthcare Provider Details

I. General information

NPI: 1922095454
Provider Name (Legal Business Name): BRIAN NIEL CHRISTIANSEN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 W TENNESSEE AVE
OAK RIDGE TN
37830-6509
US

IV. Provider business mailing address

170 W TENNESSEE AVE
OAK RIDGE TN
37830-6509
US

V. Phone/Fax

Practice location:
  • Phone: 865-482-1788
  • Fax: 865-482-1789
Mailing address:
  • Phone: 865-482-1788
  • Fax: 865-482-1789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number680
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: