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Individual

BONNIE L. CRICKMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
501 CARNES CROSSING BLVD STE B, SUMMERVILLE, SC 29486
(843) 212-8080
(843) 203-2299
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(843) 789-1620
(843) 724-2440

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11803
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000248853
UNISON
SC
01
003
BCBS
SC
01
032
TRICARE
SC
01
034
TRICARE
SC
01
061
BLUECHOICE
SC
01
063
BLUECHOICE
SC
05
118036
SC
01
20079153
SELECT HEALTH
SC
01
211988
MEDCOST
SC
01
5208053
AETNA
SC
05
5910323
NC
01
6201460
CIGNA
SC
01
B924498552
MEDICARE PTAN
SC
Enumeration date
11/08/2005
Last updated
10/30/2020
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