Provider Demographics
NPI:1699888313
Name:KING, CHRISTIE H
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:H
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 797
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:VA
Mailing Address - Zip Code:24348-0797
Mailing Address - Country:US
Mailing Address - Phone:276-773-8145
Mailing Address - Fax:276-773-3912
Practice Address - Street 1:304 DAVIS ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:VA
Practice Address - Zip Code:24348
Practice Address - Country:US
Practice Address - Phone:276-773-8145
Practice Address - Fax:276-773-3912
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01200035392471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography