Provider Demographics
NPI:1558399139
Name:ANGELA F CRISP MD PC
Entity Type:Organization
Organization Name:ANGELA F CRISP MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:F
Authorized Official - Last Name:CRISP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-217-3321
Mailing Address - Street 1:1832 WARD DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-0568
Mailing Address - Country:US
Mailing Address - Phone:615-217-3324
Mailing Address - Fax:615-217-3477
Practice Address - Street 1:1832 WARD DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-0568
Practice Address - Country:US
Practice Address - Phone:615-217-3324
Practice Address - Fax:615-217-3477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40938207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNF32731Medicare UPIN
TN3733822Medicare ID - Type Unspecified