Healthcare Provider Details

I. General information

NPI: 1477550283
Provider Name (Legal Business Name): ERIKA HAZARD CREECH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 MERIDIAN SPRINGS DR
JACKSON TN
38301-5900
US

IV. Provider business mailing address

21 MERIDIAN SPRINGS DR
JACKSON TN
38301-5900
US

V. Phone/Fax

Practice location:
  • Phone: 731-256-0526
  • Fax: 731-256-1720
Mailing address:
  • Phone: 731-256-0526
  • Fax: 731-256-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMD024799
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24799
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: