Provider Demographics
NPI:1316932205
Name:SHOLES, CHRISTOPHER W (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:W
Last Name:SHOLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 PRINCETON RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2026
Mailing Address - Country:US
Mailing Address - Phone:423-282-3377
Mailing Address - Fax:423-283-4746
Practice Address - Street 1:311 PRINCETON RD
Practice Address - Street 2:SUITE 7
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2026
Practice Address - Country:US
Practice Address - Phone:423-282-3377
Practice Address - Fax:423-283-4746
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2012-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD17105207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006065201Medicaid
TN0138353OtherBLUE CROSS BLUE SHIELD
TNTN0104OtherUNITED HEALTHCARE OF THE
NC1332FOtherBLUE CROSS
KY64009798Medicaid
NC890664AMedicaid
0004642248OtherAETNA
0020583100OtherBLACK LUNG
TN3039100Medicaid
NC183554OtherMEDCOST
TN0138353OtherBLUE CROSS BLUE SHIELD
TN0138353OtherBLUE CROSS BLUE SHIELD
TN621479972OtherEIN
NC890664AMedicaid
TN3039100Medicare PIN