| Crystal Dale Grantham, | |
| 
					210 Bay Ave, Richton, MS 39476-9665  | |
| (601) 788-9222 | |
| (601) 788-6318 | 
| Full Name | Crystal Dale Grantham | 
|---|---|
| Gender | Female | 
| Speciality | Nurse Practitioner - Family | 
| Location | 210 Bay Ave, Richton, Mississippi | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1336633791 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 363LF0000X | Nurse Practitioner - Family | 902689 (Mississippi) | Primary | 
| Entity Name | Magee Benevolent Association | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1225157258 PECOS PAC ID: 3678466463 Enrollment ID: O20040205000400  | 
| Entity Name | Forrest County General Hospital | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1295837631 PECOS PAC ID: 1052397767 Enrollment ID: O20040624001351  | 
| Entity Name | Field Memorial Community Hospital | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1881648376 PECOS PAC ID: 0547248544 Enrollment ID: O20040707001237  | 
| Entity Name | Rh Emergency Medicine Of Perry County Llc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1740058650 PECOS PAC ID: 8022461573 Enrollment ID: O20240131002979  | 
| Entity Name | Rh Hospitalist Medicine Of Perry County Llc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1821866740 PECOS PAC ID: 4688017619 Enrollment ID: O20240207000960  | 
| Entity Name | Covington County Hospital | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1003654567 PECOS PAC ID: 4183517253 Enrollment ID: O20250324000786  | 
| Mailing Address | Practice Location Address | 
|---|---|
| Crystal Dale Grantham, 210 Bay Ave, Richton, MS 39476-9665 Ph: (601) 788-9222  | Crystal Dale Grantham, 210 Bay Ave, Richton, MS 39476-9665 Ph: (601) 788-9222  | 
Ms. Janell G Carter, FNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 206 Bay Ave, Richton, MS 39476 Phone: 601-788-6316 Fax: 601-788-2230  | |
Jillian Christina Smith,  Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 91570 Highway 42, Richton, MS 39476 Phone: 601-791-2101  | |
Willena Causey,  Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 105 N Front St, Richton, MS 39476 Phone: 769-369-0010  | |
Angela Denise Haigler, NP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 4000 Highway 15 S, Richton, MS 39476 Phone: 601-319-7660  | |
Ms. Jerryl Mcgowan-craft,  Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 411 Oak Street, Richton, MS 39476 Phone: 601-408-0719  | |
Mr. James Sawyer Williams, FNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 210 Bay Ave, Richton, MS 39476 Phone: 601-788-9222  |