MEDICARE: MOTLEY & CRESTANI FAMILY PRACTICE, PC

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	:	1588611693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOTLEY & CRESTANI FAMILY PRACTICE, PC

Provider Business Mailing Address
First Line	:	PO BOX 2586
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35804-2586
Country	:	US
Telephone Number	:	256-534-1323
Fax Number	:	256-534-1780

Provider Business Practice Location Address
First Line	:	250 CHATEAU DR SW
Second Line	:	SUITE 245
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-6436
Country	:	US
Telephone Number	:	256-534-1323
Fax Number	:	256-534-1780

Authorized Official
Title or Position	:	ACCOUNTS MANAGER
Name	:	PANDA JO PALMER
Credential	:
Telephone Number	:	256-534-1323

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	08/22/2020

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