Organization
CRISP GENERAL INTERNAL MEDICINE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN HOLLOWAY M.D. (PRESIDENT)
(229) 273-4989
Entity
Organization
Contact information
Practice address
416 E 4TH AVE STE B, CORDELE, GA 31015-3729
(229) 273-8501
(229) 273-2515
Mailing address
1801 QUAIL RUN, CORDELE, GA 31015-2096
(229) 273-4989
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
060593
GA
Other
Enumeration date
06/10/2008
Last updated
06/10/2008
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