Healthcare Provider Details

I. General information

NPI: 1710046073
Provider Name (Legal Business Name): CRH PHYSICIAN PRACTICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DOCTORS DR STE A
DOUGLAS GA
31533-2211
US

IV. Provider business mailing address

PO BOX 14804
BELFAST ME
04915-4043
US

V. Phone/Fax

Practice location:
  • Phone: 912-559-0242
  • Fax: 912-838-5677
Mailing address:
  • Phone: 912-384-1477
  • Fax: 912-384-1470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAVONDA CRAVEY
Title or Position: CONTROLLER
Credential:
Phone: 912-384-1900