Basic Information
| Provider Information | |||||||||
| NPI: | 1417937483 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHRYSSON | ||||||||
| FirstName: | NICK | ||||||||
| MiddleName: | GEORGE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 75216 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282755216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367187080 | ||||||||
| FaxNumber: | 3367189622 | ||||||||
| Practice Location | |||||||||
| Address1: | 3333 SILAS CREEK PKWY | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271033013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362778800 | ||||||||
| FaxNumber: | 3362778850 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 08/07/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | 4301500685 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 892248C | 05 | NC | MEDICAID | 006005454 | 05 | VA | MEDICAID | 4249275 | 01 | NC | AETNA PPO | OTHER | P00031312 | 01 | RAILROAD MEDICARE | OTHER | 141793483 | 05 | VA | MEDICAID | 2288 | 01 | NC | PARTNERS NATIONAL HEALTH | OTHER | 44711 | 01 | NC | MEDCOST | OTHER | 3097055 | 01 | NC | AETNA HMO | OTHER | 3603477 | 01 | NC | UNITED HEALTH CARE | OTHER | 2248C | 01 | NC | BLUE CROSS BLUE SHIELD NC | OTHER |