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General NPI Number Information
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NPI Number | 1942674684
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Entity Type | Organization
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Legal Business Name | CRH PHYSICIAN PRACTICES LLC
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Dates
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Enumeration Date | 11/18/2015
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Last Update Date | 11/18/2015
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Provider Practice Location Address
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Address Line | 195 E TOLLISON ST STE A SUITE A & B
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City | BAXLEY
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State | GA
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Zip | 31513-0174
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Country | US
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Telephone | 912-384-5832
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Fax | 912-383-8279
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Provider Business Mailing Address
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Address Line | PO BOX 14804
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City | BELFAST
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State | ME
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Zip | 04915-4043
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Country | US
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Telephone | 912-384-5832
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Fax | 912-383-8279
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Authorized Official
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Title or Position | ASSISTANT DIRECTOR
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Name | NICOLE BURNAM
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Credential |
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Telephone | 912-260-5379
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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