MEDICARE: COLLIERVILLE FAMILY MEDICAL CENTER P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1063438208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLIERVILLE FAMILY MEDICAL CENTER P.C.

Provider Business Mailing Address
First Line	:	790 W POPLAR AVE
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-2544
Country	:	US
Telephone Number	:	901-853-9700
Fax Number	:	901-853-9996

Provider Business Practice Location Address
First Line	:	790 W POPLAR AVE
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-2544
Country	:	US
Telephone Number	:	901-853-9700
Fax Number	:	901-853-9996

Authorized Official
Title or Position	:	OWNER/PROVIDER/PRESIDENT
Name	:	DR. JOHN DANIEL CRAWFORD
Credential	:	M.D.
Telephone Number	:	901-853-9700

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	01/05/2010

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Practice Location Address:

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