1336469048 NPI number — HOLLY CRIM M.D.

Table of content: HOLLY CRIM M.D. (NPI 1336469048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336469048 NPI number — HOLLY CRIM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRIM
Provider First Name:
HOLLY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROBERTSON
Provider Other First Name:
HOLLY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336469048
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 W BROADWAY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARYVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37801-4703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-273-1752
Provider Business Mailing Address Fax Number:
865-273-1755

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
266 JOULE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALCOA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-984-3864
Provider Business Practice Location Address Fax Number:
865-380-4095
Provider Enumeration Date:
06/03/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD50276 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)