Provider Demographics
NPI:1104890516
Name:JEPPSON, CHRISTOPHER HAL (SCAT)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:HAL
Last Name:JEPPSON
Suffix:
Gender:M
Credentials:SCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 DAHOON LN
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-4907
Mailing Address - Country:US
Mailing Address - Phone:540-209-5215
Mailing Address - Fax:
Practice Address - Street 1:300 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-3742
Practice Address - Country:US
Practice Address - Phone:843-383-8390
Practice Address - Fax:843-383-8169
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001231A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN225500000XOtherSPECIALIST/TECHNOLOGIST