Healthcare Provider Details

I. General information

NPI: 1689085540
Provider Name (Legal Business Name): MS. CRYSTAL MICHELLE PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 GREENSPAN WAY
BYRON GA
31008-9528
US

IV. Provider business mailing address

125 GREENSPAN WAY
BYRON GA
31008-9528
US

V. Phone/Fax

Practice location:
  • Phone: 478-442-0701
  • Fax:
Mailing address:
  • Phone: 478-442-0701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: