Healthcare Provider Details

I. General information

NPI: 1558394437
Provider Name (Legal Business Name): GREGORY HANNIBAL CRISP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E CORNWALLIS DR STE G
GREENSBORO NC
27405
US

IV. Provider business mailing address

PO BOX 7432
GREENSBORO NC
27417-0432
US

V. Phone/Fax

Practice location:
  • Phone: 336-763-1101
  • Fax: 866-959-7250
Mailing address:
  • Phone: 803-356-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25487
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number25487
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25487
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number25487
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number25487
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: