Provider Demographics
NPI:1417973330
Name:CROWELL, WESLEY C (MD)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:C
Last Name:CROWELL
Suffix:
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 1:101 FITNESS WAY
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-3620
Mailing Address - Country:US
Mailing Address - Phone:256-233-0712
Mailing Address - Fax:256-233-3535
Practice Address - Street 1:101 FITNESS WAY
Practice Address - Street 2:STE 1100
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-3620
Practice Address - Country:US
Practice Address - Phone:256-233-0712
Practice Address - Fax:256-233-3535
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25244208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009927945Medicaid
AL51517667OtherBLUE CROSS BLUE SHIELD
AL51517667OtherBLUE CROSS BLUE SHIELD
AL009927945Medicaid