Provider Demographics
NPI:1063402022
Name:MCGHEE, CHRISTY G (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:G
Last Name:MCGHEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 FORT HENRY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-2256
Mailing Address - Country:US
Mailing Address - Phone:423-239-1550
Mailing Address - Fax:423-239-1544
Practice Address - Street 1:16000 JOHNSTON MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-7664
Practice Address - Country:US
Practice Address - Phone:423-844-6450
Practice Address - Fax:423-844-6499
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN786363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP01315837OtherRR MEDICARE
TN3668925Medicaid
VA1063402022Medicaid
VAVV9898AMedicare PIN
TN3668925Medicaid
TN3668925Medicare PIN
TN970015863Medicare PIN
TNS94488Medicare UPIN