Healthcare Provider Details

I. General information

NPI: 1992962401
Provider Name (Legal Business Name): CANDICE SALLY CREWSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CANDICE SALLY CHORLEY

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 01/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 FRANKLIN RD STE 210
BRENTWOOD TN
37027-5250
US

IV. Provider business mailing address

515 STONECREST PKWY STE 210
SMYRNA TN
37167-6826
US

V. Phone/Fax

Practice location:
  • Phone: 615-373-2248
  • Fax: 615-373-5116
Mailing address:
  • Phone: 615-625-7112
  • Fax: 615-625-7028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number47247
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: