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NPI Code Detail

MEDICARE: DR. JONATHAN GENTRY CRISP MD

MEDICARE: DR. JONATHAN GENTRY CRISP MD
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
12084P0800XPsychiatry Physician9700221NC
22084P0800XPsychiatry Physician0101239503VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598735417
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JONATHAN GENTRY CRISP MD
Provider Business Mailing Address
First Line : 340 BAGLEY CIR
Second Line :
City : MARION
State : VA
Zip : 24354-3126
Country : US
Telephone Number : 276-783-1226
Fax Number : 276-783-1425
Provider Business Practice Location Address
First Line : 340 BAGLEY CIR
Second Line :
City : MARION
State : VA
Zip : 24354-3126
Country : US
Telephone Number : 276-783-1226
Fax Number : 276-783-1425
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2006
Last Update Date : 08/10/2008

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