MEDICARE: CRESTWYN HEALTH GROUP, LLC

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1417458944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRESTWYN HEALTH GROUP, LLC

Provider Business Mailing Address
First Line	:	4020 ASPEN GROVE DR STE 900
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-3134
Country	:	US
Telephone Number	:	615-861-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	9485 CRESTWYN HILLS DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38125-8515
Country	:	US
Telephone Number	:	855-248-4757
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT & SECRETARY
Name	:	BRIAN P FARLEY
Credential	:
Telephone Number	:	615-861-6000

Provider Enumeration Date	:	02/21/2018
Last Update Date	:	01/20/2026

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