MEDICARE: JAMES G CHRISTMAS III LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904004995	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	733393000	OTHER	MAGELLAN
2	307351	OTHER	ANTHEM
3	7944737	OTHER	AETNA
4	089424M	OTHER	OPTIMA
5	2324656	OTHER	CIGNA
6	182233	OTHER	ANTHEM

General Provider Information

NPI Number	:	1053388967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES G CHRISTMAS III LCSW

Provider Business Mailing Address
First Line	:	3113 ROLLING OAKS CT
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23234-6718
Country	:	US
Telephone Number	:	804-683-6590
Fax Number	:	804-230-0998

Provider Business Practice Location Address
First Line	:	1012 HULL ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224-4072
Country	:	US
Telephone Number	:	804-230-0999
Fax Number	:	804-230-0998

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	07/05/2011

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