Healthcare Provider Details

I. General information

NPI: 1891016846
Provider Name (Legal Business Name): CRYSTAL LAVETTE WELCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CRYSTAL WELCH GOODMAN MD

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 PEACHTREE ST NW STE 500
ATLANTA GA
30309-2509
US

IV. Provider business mailing address

1800 PEACHTREE ST NW STE 500
ATLANTA GA
30309-2509
US

V. Phone/Fax

Practice location:
  • Phone: 770-702-0101
  • Fax: 770-702-0570
Mailing address:
  • Phone: 770-702-0101
  • Fax: 770-702-0570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number72480
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: