Healthcare Provider Details

I. General information

NPI: 1437561446
Provider Name (Legal Business Name): COURTNEY CRIPPS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2014
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 KROG ST NE # C110
ATLANTA GA
30307-2677
US

IV. Provider business mailing address

99 KROG ST NE # C110
ATLANTA GA
30307-2677
US

V. Phone/Fax

Practice location:
  • Phone: 404-885-8542
  • Fax:
Mailing address:
  • Phone: 404-885-8542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number036159879
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number113442
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: