Healthcare Provider Details

I. General information

NPI: 1487031365
Provider Name (Legal Business Name): CRYSTAL ANN STANTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 POPLAR AVE STE 800
MEMPHIS TN
38157-0800
US

IV. Provider business mailing address

5050 POPLAR AVE STE 800
MEMPHIS TN
38157-0800
US

V. Phone/Fax

Practice location:
  • Phone: 901-276-2662
  • Fax:
Mailing address:
  • Phone: 901-276-2662
  • Fax:

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 Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number65726
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number65726
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number65726
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number65726
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: