Healthcare Provider Details

I. General information

NPI: 1114488020
Provider Name (Legal Business Name): CRYSTAL N COMPTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2470 DANIELLS BRIDGE RD STE 251
ATHENS GA
30606-6192
US

IV. Provider business mailing address

PO BOX 48089
ATHENS GA
30604-8089
US

V. Phone/Fax

Practice location:
  • Phone: 706-389-3440
  • Fax: 706-353-2205
Mailing address:
  • Phone: 706-389-3440
  • Fax: 706-353-2205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN177262
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: