Provider Demographics
NPI:1255534046
Name:CRAWFORD, CARLOTTA M G (CNM)
Entity type:Individual
Prefix:MRS
First Name:CARLOTTA
Middle Name:M G
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MS
Other - First Name:CARLOTTA
Other - Middle Name:M G
Other - Last Name:SHANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, MN, MPH
Mailing Address - Street 1:404 DR DB TODD JR BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2896
Mailing Address - Country:US
Mailing Address - Phone:615-291-9923
Mailing Address - Fax:615-678-6470
Practice Address - Street 1:404 DR DB TODD JR BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2896
Practice Address - Country:US
Practice Address - Phone:615-291-9923
Practice Address - Fax:615-678-6470
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005719367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3661295Medicaid
TN103 I 423231Medicare PIN