1982761334 NPI number — ERIN L. CROWSON PA

Table of content: ERIN L. CROWSON PA (NPI 1982761334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982761334 NPI number — ERIN L. CROWSON PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROWSON
Provider First Name:
ERIN
Provider Middle Name:
L.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CALLAHAN
Provider Other First Name:
ERIN
Provider Other Middle Name:
L.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982761334
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3400 OLD MILTON PKWY # C
Provider Second Line Business Mailing Address:
SUITE 290
Provider Business Mailing Address City Name:
ALPHARETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30005-3707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-667-4337
Provider Business Mailing Address Fax Number:
770-667-4338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1505 NORTHSIDE FORSYTH BLVD
Provider Second Line Business Practice Location Address:
STE 3500
Provider Business Practice Location Address City Name:
CUMMING
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-292-6500
Provider Business Practice Location Address Fax Number:
770-292-6535
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  004165 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 670065849A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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