Healthcare Provider Details

I. General information

NPI: 1295772721
Provider Name (Legal Business Name): CRISSMAN FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E ELM ST
GRAHAM NC
27253-3022
US

IV. Provider business mailing address

214 E ELM ST
GRAHAM NC
27253-3022
US

V. Phone/Fax

Practice location:
  • Phone: 336-226-2448
  • Fax: 336-226-5894
Mailing address:
  • Phone: 336-226-2448
  • Fax: 336-226-5894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK ANDERS CRISSMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 336-226-2448