MEDICARE: COLLIERVILLE FAMILY MEDICAL CENTER P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1063438208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLIERVILLE FAMILY MEDICAL CENTER P.C.

Provider Business Mailing Address
First Line	:	790 W POPLAR AVE
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-2544
Country	:	US
Telephone Number	:	901-853-9700
Fax Number	:	901-853-9996

Provider Business Practice Location Address
First Line	:	790 W POPLAR AVE
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-2544
Country	:	US
Telephone Number	:	901-853-9700
Fax Number	:	901-853-9996

Authorized Official
Title or Position	:	OWNER/PROVIDER/PRESIDENT
Name	:	DR. JOHN DANIEL CRAWFORD
Credential	:	M.D.
Telephone Number	:	901-853-9700

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	01/05/2010

Similar Medicare Providers

1215930094 — DR. OWITA R MAYS MD
Practice Location Address:

1500 W. POPLAR AVENUE , SUITE 202
COLLIERVILLE, TN
38017-2544

Practice Phone: 901-861-9090
Practice Fax: 901-861-9099

1811933120 — SANDRA L KIRKLAND DNS FNP, BC
Practice Location Address:

790 W POPLAR AVE
COLLIERVILLE, TN
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1669808051 — EMILY MEWBORN APRN
Practice Location Address:

790 W POPLAR AVE , SUITE 1
COLLIERVILLE, TN
38017-2544

Practice Phone: 901-853-9700
Practice Fax: 901-853-9996

1801397096 — DR. LORI MCMAHAN STEPP DNP, APRN, FNP-C
Practice Location Address:

1500 W POPLAR AVE
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Practice Fax:

1245665850 — PROCARE PHARMACY, LLC.
Practice Location Address:

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1457213985 — JONETTE HODGE
Practice Location Address:

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Practice Phone: 901-626-8447
Practice Fax: 901-626-8447

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