1255534046 NPI number — MRS. CARLOTTA M. G. CRAWFORD CNM

Table of content: MRS. CARLOTTA M. G. CRAWFORD CNM (NPI 1255534046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255534046 NPI number — MRS. CARLOTTA M. G. CRAWFORD CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRAWFORD
Provider First Name:
CARLOTTA
Provider Middle Name:
M. G.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHANKS
Provider Other First Name:
CARLOTTA
Provider Other Middle Name:
M. G.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CNM, MN, MPH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255534046
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
404 DR DB TODD JR BLVD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37203-2896
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-291-9923
Provider Business Mailing Address Fax Number:
615-678-6470

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
404 DR DB TODD JR BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37203-2896
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-291-9923
Provider Business Practice Location Address Fax Number:
615-678-6470
Provider Enumeration Date:
06/08/2007

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: 367A00000X , with the licence number:  APN0000005719 , 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)

  • Identifier: 3661295 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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