Healthcare Provider Details

I. General information

NPI: 1124058532
Provider Name (Legal Business Name): JACQUELINE CRAWFORD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 PARKSIDE DR SUITE 203
KNOXVILLE TN
37934-1922
US

IV. Provider business mailing address

10800 PARKSIDE DR SUITE 203
KNOXVILLE TN
37934-1922
US

V. Phone/Fax

Practice location:
  • Phone: 865-218-8333
  • Fax: 865-218-6228
Mailing address:
  • Phone: 865-218-8333
  • Fax: 865-218-6228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberMD30506
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD30506
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: