Provider Demographics
NPI:1790566271
Name:DOMINIQUE CRAIN LOCUMS LLC
Entity Type:Organization
Organization Name:DOMINIQUE CRAIN LOCUMS LLC
Other - Org Name:DC LOCUMS FAMILY MEDICINE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER/CEO/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:JUANITA
Authorized Official - Last Name:CRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:470-491-4328
Mailing Address - Street 1:PO BOX 851982
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36685-1982
Mailing Address - Country:US
Mailing Address - Phone:470-491-4328
Mailing Address - Fax:
Practice Address - Street 1:6660 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-3167
Practice Address - Country:US
Practice Address - Phone:470-491-4328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-10
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty