Provider Demographics
NPI:1508916610
Name:CRESENT MEDICAL, PLLC
Entity Type:Organization
Organization Name:CRESENT MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-586-1811
Mailing Address - Street 1:220 N FAIRMONT AVE
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-3768
Mailing Address - Country:US
Mailing Address - Phone:423-586-1811
Mailing Address - Fax:423-581-6637
Practice Address - Street 1:220 N FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3768
Practice Address - Country:US
Practice Address - Phone:423-586-1811
Practice Address - Fax:423-581-6637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty