Basic Information
| Provider Information | |||||||||
| NPI: | 1538320668 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CROW | ||||||||
| FirstName: | ADRIENNE | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2845 E HIGHWAY 76 STE 3 | ||||||||
| Address2: | |||||||||
| City: | MULLINS | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295746037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434312740 | ||||||||
| FaxNumber: | 8434312197 | ||||||||
| Practice Location | |||||||||
| Address1: | 1810 STADIUM DR | ||||||||
| Address2: | |||||||||
| City: | PHENIX CITY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 368673177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342974883 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2008 | ||||||||
| LastUpdateDate: | 06/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 003020 | GA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 04-39972 | KS | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 35119 | SC | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 36741 | AL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | GP 5462 | 05 | SC | MEDICAID | 351194 | 05 | SC | MEDICAID | GP 9493 | 01 | SC | MEDICARE | OTHER | AA9889A | 01 | SC | MEDICARE INDIVIDUAL | OTHER |