Provider Demographics
NPI:1538320668
Name:CROW, ADRIENNE NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:NICOLE
Last Name:CROW
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 1:2845 E HIGHWAY 76 STE 3
Mailing Address - Street 2:
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574-6037
Mailing Address - Country:US
Mailing Address - Phone:843-431-2740
Mailing Address - Fax:843-431-2197
Practice Address - Street 1:1810 STADIUM DR
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-3177
Practice Address - Country:US
Practice Address - Phone:334-297-4883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003020207V00000X
KS04-39972207V00000X
SC35119207V00000X
AL36741207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP 5462Medicaid
SC351194Medicaid
SCGP 9493OtherMEDICARE
SCAA9889AOtherMEDICARE INDIVIDUAL