Healthcare Provider Details

I. General information

NPI: 1497721302
Provider Name (Legal Business Name): JOHN E CRANE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 E TOLLISON ST
BAXLEY GA
31513-0172
US

IV. Provider business mailing address

PO BOX 2070
BAXLEY GA
31515-2070
US

V. Phone/Fax

Practice location:
  • Phone: 912-367-0434
  • Fax: 912-367-0436
Mailing address:
  • Phone: 912-367-0434
  • Fax: 912-367-0436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number48342
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: