Healthcare Provider Details

I. General information

NPI: 1639990823
Provider Name (Legal Business Name): DEWAYNE NASHUN CROWDER SOCIAL WORKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 PHOENIX BLVD STE 210
ATLANTA GA
30349-5557
US

IV. Provider business mailing address

1800 PHOENIX BLVD STE 210
ATLANTA GA
30349-5557
US

V. Phone/Fax

Practice location:
  • Phone: 678-705-3814
  • Fax: 770-758-1152
Mailing address:
  • Phone: 404-901-0679
  • Fax: 678-705-3814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License NumberRN304533
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: