Provider Demographics
NPI:1215943212
Name:JUSTUS, CHRISTOPHER EUGENE (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:EUGENE
Last Name:JUSTUS
Suffix:
Gender:
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 1:1 MEDICAL PARK BLVD
Mailing Address - Street 2:SUITE 400 EAST
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-7430
Mailing Address - Country:US
Mailing Address - Phone:423-844-5400
Mailing Address - Fax:423-844-5434
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:SUITE 400 EAST
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7430
Practice Address - Country:US
Practice Address - Phone:423-844-5400
Practice Address - Fax:423-844-5434
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1083363A00000X, 363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1512863Medicaid
TN1512863Medicaid
Q24096Medicare UPIN