Provider Demographics
NPI:1861589517
Name:BURKS, CHRISTOPHER ANDREW (AU D, CCCA)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:ANDREW
Last Name:BURKS
Suffix:
Gender:M
Credentials:AU D, CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-3929
Mailing Address - Country:US
Mailing Address - Phone:423-914-2846
Mailing Address - Fax:
Practice Address - Street 1:306 SUNSET DR
Practice Address - Street 2:SUITE 103
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2492
Practice Address - Country:US
Practice Address - Phone:423-328-9190
Practice Address - Fax:423-328-9189
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNA0000001468231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPENDINGOtherBLUE CROSS PROVIDER
TNPENDINGOtherBLUE CROSS PROVIDER
TNCA7519OtherRAILROAD MEDICARE
TN3967223Medicaid