Basic Information
| Provider Information | |||||||||
| NPI: | 1063736098 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MABRY | ||||||||
| FirstName: | CHRISTIAN | ||||||||
| MiddleName: | CARL | ||||||||
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| OtherLastName: | MABRY | ||||||||
| OtherFirstName: | CARL | ||||||||
| OtherMiddleName: | CHRISTIAN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 300 E MCBEE AVE FL 4 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296012842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645228617 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 67 CREEKSIDE PARK CT | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296154810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645223700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2010 | ||||||||
| LastUpdateDate: | 05/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 282706-1 | NY | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 25MA09290100 | NJ | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 84795 | SC | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.