Provider Demographics
NPI:1942592613
Name:BLANCHARD, CHRISTOPHER STEVEN (DO)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:STEVEN
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 DEPUTY BILL CANTRELL MEMORIAL RD
Mailing Address - Street 2:STE. 300
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040
Mailing Address - Country:US
Mailing Address - Phone:770-886-8111
Mailing Address - Fax:770-205-8539
Practice Address - Street 1:4150 DEPUTY BILL CANTRELL MEMORIAL RD.
Practice Address - Street 2:STE. 300
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040
Practice Address - Country:US
Practice Address - Phone:770-886-8111
Practice Address - Fax:770-205-8539
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-00752207X00000X
390200000X
GA076441207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ52016Medicaid
NC1942592613Medicaid
NCNCU566CMedicare PIN
SCQ52016Medicaid