MEDICARE: MRS. SHALIMAR SHEREE CROWE ATC/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	AT001020	GA

General Provider Information

NPI Number	:	1154351591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHALIMAR SHEREE CROWE ATC/L

Provider Business Mailing Address
First Line	:	491 CAREYTOWN RD
Second Line	:
City	:	ROYSTON
State	:	GA
Zip	:	30662-3304
Country	:	US
Telephone Number	:	706-245-8657
Fax Number	:

Provider Business Practice Location Address
First Line	:	181 SPRING ST
Second Line	:
City	:	ROYSTON
State	:	GA
Zip	:	30662
Country	:	US
Telephone Number	:	706-245-7226
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/08/2007

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