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General NPI Number Information
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NPI Number | 1013345453
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Entity Type | Individual
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Provider Name | JACK CRAWFORD CSA, CST
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Gender | Male
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Dates
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Enumeration Date | 10/22/2013
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Last Update Date | 10/22/2013
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Provider Practice Location Address
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Address Line | 3121 BRIMSTEAD DR
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City | FRANKLIN
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State | TN
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Zip | 37064-6225
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Country | US
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Telephone | 615-775-8953
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Fax |
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Provider Business Mailing Address
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Address Line | 3121 BRIMSTEAD DR
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City | FRANKLIN
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State | TN
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Zip | 37064-6225
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Country | US
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Telephone | 615-775-8953
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 10-227
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License Number State | TN
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