Provider Demographics
NPI:1043308786
Name:JOHN D CRANWELL MD PLLC
Entity Type:Organization
Organization Name:JOHN D CRANWELL MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CRANWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-886-2004
Mailing Address - Street 1:PO BOX 102327
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2327
Mailing Address - Country:US
Mailing Address - Phone:423-886-2004
Mailing Address - Fax:423-886-7803
Practice Address - Street 1:2600 TAFT HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:SIGNAL MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37377-2774
Practice Address - Country:US
Practice Address - Phone:423-886-2004
Practice Address - Fax:423-886-7803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9391207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB03399Medicare UPIN