Provider Demographics
NPI:1154337228
Name:FORD-CRAWFORD, LISA DANITA (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:DANITA
Last Name:FORD-CRAWFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6341 PICCADILLY SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-5103
Mailing Address - Country:US
Mailing Address - Phone:251-343-5300
Mailing Address - Fax:251-343-6613
Practice Address - Street 1:6341 PICCADILLY SQUARE DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-5103
Practice Address - Country:US
Practice Address - Phone:251-343-5300
Practice Address - Fax:251-343-6613
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL333712084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2103253Medicare ID - Type Unspecified
OH691423Medicare UPIN