Healthcare Provider Details

I. General information

NPI: 1740649623
Provider Name (Legal Business Name): CRH PHYSICIAN PRACTICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2016
Last Update Date: 04/12/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DOCTORS DR SUITE G
DOUGLAS GA
31533-2210
US

IV. Provider business mailing address

PO BOX 1377
DOUGLAS GA
31534-1377
US

V. Phone/Fax

Practice location:
  • Phone: 912-384-6186
  • Fax: 912-384-6187
Mailing address:
  • Phone: 912-384-1477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: LAVONDA CRAVEY
Title or Position: VP OF CORPORATE REVENUE CYCLE
Credential:
Phone: 912-384-1900