Provider Demographics
NPI:1477583516
Name:CRANDELL, DONNA CHARLENE (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:CHARLENE
Last Name:CRANDELL
Suffix:
Gender:F
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:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-0639
Mailing Address - Country:US
Mailing Address - Phone:256-332-7350
Mailing Address - Fax:
Practice Address - Street 1:5682 HIGHWAY 73
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-6387
Practice Address - Country:US
Practice Address - Phone:256-332-7350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL108632085R0202X
GA157492085R0202X
MS062812085R0202X
OK94562085R0202X
TN59822085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Not Answered2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL35295Medicaid
AL35295Medicaid
C76070Medicare UPIN