=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922406735
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALAN L. CREWS MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2014
-----------------------------------------------------
Last Update Date | 12/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 163 WALNUT GROVE CHURCH RD
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37321-6104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-775-6668
-----------------------------------------------------
Fax | 423-775-1054
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 163 WALNUT GROVE CHURCH RD
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37321-6104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-775-6668
-----------------------------------------------------
Fax | 423-775-1054
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ALAN L CREWS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 423-775-6668
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------