Healthcare Provider Details

I. General information

NPI: 1841172012
Provider Name (Legal Business Name): EVELYN CROSSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 MULKEY RD
AUSTELL GA
30106-1151
US

IV. Provider business mailing address

9425 GRANDE DR
WINSTON GA
30187-2302
US

V. Phone/Fax

Practice location:
  • Phone: 770-694-6349
  • Fax:
Mailing address:
  • Phone: 470-347-2002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number279555
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: