Basic Information
| Provider Information | |||||||||
| NPI: | 1629295209 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POKABLA | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | MARK | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6077 PRIMACY PKWY STE 140 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381195742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012591673 | ||||||||
| FaxNumber: | 9012597637 | ||||||||
| Practice Location | |||||||||
| Address1: | 3045 KATE BOND RD | ||||||||
| Address2: | |||||||||
| City: | BARTLETT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013814664 | ||||||||
| FaxNumber: | 9013734870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 01/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 20320 | MS | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 45413 | TN | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | 20320 | MS | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207XX0005X | 45413 | TN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 45413 | 01 | TN | MEDICAL LICENSE | OTHER | 20320 | 01 | MS | MEDICAL LICENSE | OTHER | 00775733 | 01 | TN | MEDICARE RR | OTHER | 89964 | 01 | OH | MEDICAL LICENSE | OTHER | 1516507 | 05 | TN | MEDICAID | 4241859 | 01 | TN | BCBS OF TN | OTHER | 9329389 | 01 | AETNA | OTHER |