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General NPI Number Information
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NPI Number | 1154622520
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Entity Type | Organization
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Legal Business Name | CRESTWOOD PHYSICIAN SERVICES, LLC
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Dates
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Enumeration Date | 11/16/2010
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Last Update Date | 01/09/2020
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Provider Practice Location Address
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Address Line | 4810 WHITESPORT CIR SW SUITE 201
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City | HUNTSVILLE
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State | AL
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Zip | 35801-7419
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Country | US
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Telephone | 256-429-5248
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Fax | 256-429-5247
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Provider Business Mailing Address
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Address Line | PO BOX 689022
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City | FRANKLIN
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State | TN
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Zip | 37068-9022
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP PHYSICIAN BUSINESS SERVICES
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Name | JAMES PATRICK WRIGHT
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Credential |
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Telephone | 615-778-1502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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