Provider Demographics
NPI:1841278520
Name:CROMWELL, JANET LARD (MD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:LARD
Last Name:CROMWELL
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 1:195 ENOCH BLVD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-2240
Mailing Address - Country:US
Mailing Address - Phone:731-926-1502
Mailing Address - Fax:731-926-4062
Practice Address - Street 1:195 ENOCH BLVD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-2240
Practice Address - Country:US
Practice Address - Phone:731-926-1502
Practice Address - Fax:731-926-4062
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15250207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3013438Medicaid
26884OtherTLC
4066839OtherBCBS
A97742Medicare UPIN
3013438Medicare ID - Type Unspecified