Provider Demographics
NPI:1194737726
Name:MINA, CHRISTIE B (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIE
Middle Name:B
Last Name:MINA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3 SAINT FRANCIS DR
Mailing Address - Street 2:SUITE 490
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3973
Mailing Address - Country:US
Mailing Address - Phone:864-220-4263
Mailing Address - Fax:864-220-5836
Practice Address - Street 1:3 SAINT FRANCIS DR
Practice Address - Street 2:SUITE 490
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3973
Practice Address - Country:US
Practice Address - Phone:864-220-4263
Practice Address - Fax:864-220-5836
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC22496207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC22496OtherSTATE LICENSE NUMBER
GA00928551BMedicaid
SC224965Medicaid
SCBM7401324OtherDEA NUMBER
GA00928551BMedicaid
SC22496OtherSTATE LICENSE NUMBER