MEDICARE: CHARLES B CROW III, MD, 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	207R00000X	Internal Medicine Physician	7326	AL

General Provider Information

NPI Number	:	1437459179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES B CROW III, MD, LLC

Provider Business Mailing Address
First Line	:	34 TOWN HALL LN
Second Line	:
City	:	HARPERSVILLE
State	:	AL
Zip	:	35078-4718
Country	:	US
Telephone Number	:	205-672-2401
Fax Number	:

Provider Business Practice Location Address
First Line	:	34 TOWN HALL LN
Second Line	:
City	:	HARPERSVILLE
State	:	AL
Zip	:	35078-4718
Country	:	US
Telephone Number	:	205-672-2401
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHARLES B CROW III
Credential	:	MD
Telephone Number	:	205-672-2401

Provider Enumeration Date	:	10/28/2010
Last Update Date	:	10/28/2010

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