Provider Demographics
NPI:1609931799
Name:HUMBLE, STEPHEN CRENSHAW (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CRENSHAW
Last Name:HUMBLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 CHURCH ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2000
Mailing Address - Country:US
Mailing Address - Phone:615-340-4677
Mailing Address - Fax:615-284-4679
Practice Address - Street 1:2011 CHURCH ST
Practice Address - Street 2:SUITE 501
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2000
Practice Address - Country:US
Practice Address - Phone:615-340-4677
Practice Address - Fax:615-284-4679
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD183402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3060311Medicaid
TN124165OtherBCBS
TNE85643Medicare UPIN
TN3060311Medicaid