Healthcare Provider Details

I. General information

NPI: 1003989070
Provider Name (Legal Business Name): CRH PHYSICIAN PRACTICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DOCTORS DR SUITE 201
DOUGLAS GA
31533-2210
US

IV. Provider business mailing address

PO BOX 1377
DOUGLAS GA
31534-1377
US

V. Phone/Fax

Practice location:
  • Phone: 912-383-7976
  • Fax: 912-383-7974
Mailing address:
  • Phone: 912-393-3458
  • Fax: 912-383-7007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT LYNWOOD SMITH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 912-383-7976