Healthcare Provider Details

I. General information

NPI: 1780281477
Provider Name (Legal Business Name): JENNIFER JOY CROOKS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2154 JOHNSON FERRY RD NE
BROOKHAVEN GA
30319-2558
US

IV. Provider business mailing address

195 HAMILTON MULBERRY GROVE RD
CATAULA GA
31804-2503
US

V. Phone/Fax

Practice location:
  • Phone: 678-732-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN238307
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3-000112
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: