Provider Demographics
NPI:1053314427
Name:CRABTREE, JOHN DENNIE JR
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DENNIE
Last Name:CRABTREE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 CEDAR LN
Mailing Address - Street 2:STE 100
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-4760
Mailing Address - Country:US
Mailing Address - Phone:931-455-7779
Mailing Address - Fax:931-454-2376
Practice Address - Street 1:1750 CEDAR LN
Practice Address - Street 2:STE 100
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-4760
Practice Address - Country:US
Practice Address - Phone:931-455-7779
Practice Address - Fax:931-454-2376
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD023887208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN621735607OtherTRICARE
TN4400031002OtherCIGNA
TN020040539OtherRAILROAD MEDICARE
TN3092513OtherBC/BS TN
TN3092513Medicaid
TN1740322OtherUNITED HEALTHCARE
TN4400031002OtherCIGNA
TN1740322OtherUNITED HEALTHCARE