1467445593 NPI number — DEBRA L CRAWLEY-MATAOSKY MD

Table of content: DEBRA L CRAWLEY-MATAOSKY MD (NPI 1467445593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467445593 NPI number — DEBRA L CRAWLEY-MATAOSKY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRAWLEY-MATAOSKY
Provider First Name:
DEBRA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467445593
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 807
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SWAINSBORO
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30401-0807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-237-2638
Provider Business Mailing Address Fax Number:
478-237-9138

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
316 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SWAINSBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30401-3535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-237-2638
Provider Business Practice Location Address Fax Number:
478-237-9138
Provider Enumeration Date:
08/24/2005

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: 207Q00000X , with the licence number:  033573 , 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: 111814 . This is a "UGS-WARRENTON" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 111889 . This is a "UGS-SOPERTON" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 08BDFLS . This is a "MEDICARE FFS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 111811 . This is a "UGS-SPARTA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 111830 . This is a "UGS-SWAINSBORO" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 111812 . This is a "UGS-GIBSON" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 111813 . This is a "UGS-CRAWFORDVILLE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 111887 . This is a "UGS REIDSVILLE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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