Healthcare Provider Details

I. General information

NPI: 1053314427
Provider Name (Legal Business Name): JOHN DENNIE CRABTREE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 CEDAR LN STE 100
TULLAHOMA TN
37388-4760
US

IV. Provider business mailing address

1750 CEDAR LN STE 100
TULLAHOMA TN
37388-4760
US

V. Phone/Fax

Practice location:
  • Phone: 931-455-7779
  • Fax: 931-454-2376
Mailing address:
  • Phone: 931-455-7779
  • Fax: 931-454-2376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD023887
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: