Basic Information
| Provider Information | |||||||||
| NPI: | 1922047489 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRABB | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | LUTHER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 36 NORTHWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383014450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7313944596 | ||||||||
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| Practice Location | |||||||||
| Address1: | 176 W UNIVERSITY PKWY STE C | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383051618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316606915 | ||||||||
| FaxNumber: | 7316684557 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 09/05/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 07971 | TN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | MD7971 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207W00000X | MD7971 | TN | N | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 4175853 | 01 | TN | BCBS | OTHER | P00233179 | 01 | TN | RAILROAD MEDICARE | OTHER | 4108241 | 01 | TN | BCBS | OTHER | 31528111 | 01 | TN | MEDICAID | OTHER | 3152816 | 05 | TN | MEDICAID |