Individual
JENNIFER CRUTCHFIELD SQUIRES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2630 E 7TH ST STE 101, CHARLOTTE, NC 28204-4319
(704) 384-1000
(704) 384-1012
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-1000
(704) 384-1012
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2013-01668
NC
208000000X
Pediatrics Physician
4240
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073834214
—
NC
Enumeration date
06/22/2010
Last updated
10/28/2020
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