Provider Demographics
NPI:1174644975
Name:CRISP, JR., HUGHES TATE (BA)
Entity Type:Individual
Prefix:MR
First Name:HUGHES
Middle Name:TATE
Last Name:CRISP, JR.
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 CONCORD CHASE CIR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-5192
Mailing Address - Country:US
Mailing Address - Phone:704-376-7180
Mailing Address - Fax:
Practice Address - Street 1:1233 CONCORD CHASE CIR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-5192
Practice Address - Country:US
Practice Address - Phone:704-449-0269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator