MEDICARE: CRESTPOINT PSYCHIATRIC CARE, LLC

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1679040075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRESTPOINT PSYCHIATRIC CARE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 4358
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37602-4358
Country	:	US
Telephone Number	:	423-913-4188
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 PRINCETON RD STE 18
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-2025
Country	:	US
Telephone Number	:	423-631-0024
Fax Number	:	423-631-0047

Authorized Official
Title or Position	:	PSYCHIATRIST
Name	:	FAITH AIMUA
Credential	:	M.D
Telephone Number	:	423-631-0024

Provider Enumeration Date	:	10/24/2018
Last Update Date	:	07/28/2020

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