Basic Information
| Provider Information | |||||||||
| NPI: | 1114235504 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EGAN | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 SIGMA DR | ||||||||
| Address2: | STE 100 | ||||||||
| City: | SUMMERVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294867715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8039433813 | ||||||||
| FaxNumber: | 8039435971 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 OKATIE CTR BLVD STE 350 | ||||||||
| Address2: | |||||||||
| City: | OKATIE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299097511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437062255 | ||||||||
| FaxNumber: | 8437062257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2010 | ||||||||
| LastUpdateDate: | 12/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/19/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 1576 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1062PA | 05 | SC | MEDICAID | P00891752 | 01 | SC | RR MEDICARE | OTHER |