MEDICARE: DOMINIQUE CRAIN LOCUMS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	282N00000X	General Acute Care Hospital
2	207Q00000X	Family Medicine Physician
3	261QP2300X	Primary Care Clinic/Center
4	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1790566271
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOMINIQUE CRAIN LOCUMS LLC

Provider Business Mailing Address
First Line	:	PO BOX 851982
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36685-1982
Country	:	US
Telephone Number	:	470-491-4328
Fax Number	:

Provider Business Practice Location Address
First Line	:	6660 ROSWELL RD
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-3167
Country	:	US
Telephone Number	:	470-491-4328
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER/CEO/PHYSICIAN
Name	:	DR. DOMINIQUE JUANITA CRAIN
Credential	:	MD
Telephone Number	:	470-491-4328

Provider Enumeration Date	:	10/10/2023
Last Update Date	:	01/08/2024

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