Basic Information
| Provider Information | |||||||||
| NPI: | 1407385511 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRUM | ||||||||
| FirstName: | RACHAL | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1320 MAPLEWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | RONCEVERTE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 249708016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047932220 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 501 REDMOND RD NW | ||||||||
| Address2: | |||||||||
| City: | ROME | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301651415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062910291 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2017 | ||||||||
| LastUpdateDate: | 01/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 3602 | WV | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 324510 | LA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 0102206256 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 86533 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | 3602 | WV | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 324510 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 86533 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 0102206256 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 324510 | LA | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 3602 | WV | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 0102206256 | VA | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 86533 | GA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.