MEDICARE: DR. SHREAREST MIGNON CRENSHAW M.D.

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	39250	TN

General Provider Information

NPI Number	:	1619976735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHREAREST MIGNON CRENSHAW M.D.

Provider Business Mailing Address
First Line	:	6005 PARK AVE
Second Line	:	STE 704
City	:	MEMPHIS
State	:	TN
Zip	:	38119-5202
Country	:	US
Telephone Number	:	901-684-4646
Fax Number	:

Provider Business Practice Location Address
First Line	:	6005 PARK AVE
Second Line	:	STE 704
City	:	MEMPHIS
State	:	TN
Zip	:	38119-5202
Country	:	US
Telephone Number	:	901-684-4646
Fax Number	:	901-684-4650

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	12/21/2012

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