=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508916610
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CRESENT MEDICAL, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 N FAIRMONT AVE
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37814-3768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-586-1811
-----------------------------------------------------
Fax | 423-581-6637
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 220 N FAIRMONT AVE
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37814-3768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-586-1811
-----------------------------------------------------
Fax | 423-581-6637
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | WAYNE MCLEMORE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 423-586-1811
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------