1619608114 NPI number — BRANDY KATHERINE CRAWFORD MSN, APRN, PMHNP-BC

Table of content: ELIZABETH ANN JOHNSON LSW (NPI 1720685100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619608114 NPI number — BRANDY KATHERINE CRAWFORD MSN, APRN, PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRAWFORD
Provider First Name:
BRANDY
Provider Middle Name:
KATHERINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, APRN, PMHNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CRAWFORD
Provider Other First Name:
BRANDY
Provider Other Middle Name:
KATHERINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN, APRN, PMHNP-BC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1619608114
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
160 BLUE LAKE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND HILL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31324-4435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-896-2102
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10393 FORD AVENUE
Provider Second Line Business Practice Location Address:
BUILDING C, SUITE 2C
Provider Business Practice Location Address City Name:
RICHMOND HILL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-445-4854
Provider Business Practice Location Address Fax Number:
912-335-3490
Provider Enumeration Date:
06/23/2022

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: 363LP0808X , with the licence number:  RN251862 , 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)





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