# CRISP GENERAL INTERNAL MEDICINE INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669632014
- **Authorized official:** DR. KEVIN HOLLOWAY M.D. (PRESIDENT)
- **Authorized official phone:** (229) 273-4989

## Contact information

- **Practice address:** 416 E 4TH AVE STE B, CORDELE, GA 31015-3729
- **Practice address phone:** (229) 273-8501
- **Practice address fax:** (229) 273-2515
- **Mailing address:** 1801 QUAIL RUN, CORDELE, GA 31015-2096
- **Mailing address phone:** (229) 273-4989

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 060593 | GA | Yes |

## Other

- **Enumeration date:** 06/10/2008
- **Last updated:** 06/10/2008