Healthcare Provider Details

I. General information

NPI: 1104763762
Provider Name (Legal Business Name): MRS. JANDALEA CRAWFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 ROBINS WAY
AUBURN GA
30011-3094
US

IV. Provider business mailing address

440 ROBINS WAY
AUBURN GA
30011-3094
US

V. Phone/Fax

Practice location:
  • Phone: 404-328-8589
  • Fax:
Mailing address:
  • Phone: 404-328-8589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number359621
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: