Organization
CRESTHAVEN INTERNAL MEDICINE ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY DEATON (PRACTICE ADMINISTRATOR)
(901) 821-8300
Entity
Organization
Contact information
Practice address
6799 GREAT OAKS ROAD # 250, CRESTHAVEN INTERNAL MEDICINE, MEMPHIS, TN 38138
(901) 821-8300
(901) 259-9793
Mailing address
PO BOX 1000 DEPT 558, CRESTHAVEN INTERNAL MEDICINE, MEMPHIS, TN 38148
(901) 821-8300
(901) 259-9793
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19006
BCBS
TN
Enumeration date
04/26/2006
Last updated
08/22/2020
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