Basic Information
| Provider Information | |||||||||
| NPI: | 1558384776 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MADISON | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | ERIC | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 OKATIE CENTER BLVD S STE 100 | ||||||||
| Address2: | |||||||||
| City: | OKATIE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299097519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437058888 | ||||||||
| FaxNumber: | 8437057024 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 SORGUM LN | ||||||||
| Address2: | |||||||||
| City: | HILTON HEAD ISLAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299285909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9804871148 | ||||||||
| FaxNumber: | 8437057024 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 10/27/2016 | ||||||||
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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 | 207Q00000X | 30671 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 12902 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1558384776 | 05 | NC | MEDICAID | 8953707 | 05 | NC | MEDICAID | 53707 | 01 | NC | NCBCBS | OTHER | 129024 | 05 | SC | MEDICAID |