Healthcare Provider Details

I. General information

NPI: 1659614733
Provider Name (Legal Business Name): COURTNEY BLAKE CRAYNE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1976 GADSDEN HWY STE 105
BIRMINGHAM AL
35235-3246
US

IV. Provider business mailing address

1976 GADSDEN HWY STE 105
BIRMINGHAM AL
35235-3246
US

V. Phone/Fax

Practice location:
  • Phone: 205-508-3982
  • Fax:
Mailing address:
  • Phone: 205-508-3982
  • Fax: 205-508-3983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.35122
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: