Provider Demographics
NPI:1093704744
Name:CRUMP, CHARLES A JR (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:CRUMP
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 MCCALLIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3323
Mailing Address - Country:US
Mailing Address - Phone:423-698-2435
Mailing Address - Fax:423-697-6110
Practice Address - Street 1:2205 MCCALLIE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3323
Practice Address - Country:US
Practice Address - Phone:423-698-2435
Practice Address - Fax:423-697-6110
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2007-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26232207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN38023241Medicaid
TN38023241Medicaid
P00414928Medicare PIN
TN38023241Medicare PIN