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General NPI Number Information
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NPI Number | 1164429825
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Entity Type | Individual
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Provider Name | TOM A CHRISTENSEN MD
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Gender | Male
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 04/30/2018
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Provider Practice Location Address
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Address Line | 3600 SEA MOUNTAIN HIGWAY SUITE C
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City | LITTLE RIVER
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State | SC
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Zip | 29566
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Country | US
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Telephone | 843-399-4848
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Fax | 910-653-2346
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Provider Business Mailing Address
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Address Line | AGAPE SENIOR PRIMARY CARE INC DBA MAIN STREET PHYSICIAN 1624 MAIN STREET
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City | COLUMBIA
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State | SC
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Zip | 29201-2818
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Country | US
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Telephone | 803-726-2350
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Fax | 803-753-9102
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 18363
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License Number State | SC
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