Provider Demographics
NPI:1437459179
Name:CHARLES B CROW III, MD, LLC
Entity Type:Organization
Organization Name:CHARLES B CROW III, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:B
Authorized Official - Last Name:CROW
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:205-672-2401
Mailing Address - Street 1:34 TOWN HALL LN
Mailing Address - Street 2:
Mailing Address - City:HARPERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35078-4718
Mailing Address - Country:US
Mailing Address - Phone:205-672-2401
Mailing Address - Fax:
Practice Address - Street 1:34 TOWN HALL LN
Practice Address - Street 2:
Practice Address - City:HARPERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35078-4718
Practice Address - Country:US
Practice Address - Phone:205-672-2401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7326207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty