Healthcare Provider Details

I. General information

NPI: 1376780999
Provider Name (Legal Business Name): MARY CRANDALL CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 JOHNSON FERRY RD NE CHILDRENS REHAB ASSOC AT CHILDR
ATLANTA GA
30342-1605
US

IV. Provider business mailing address

3104 LEXINGTON FARMS DR
ALPHARETTA GA
30004-6750
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-3800
  • Fax: 404-785-3808
Mailing address:
  • Phone: 770-797-5491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License NumberRN218676
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN218676
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: