Healthcare Provider Details

I. General information

NPI: 1922121490
Provider Name (Legal Business Name): JOHN JAY CRUMPTON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 HELEN HWY
CLEVELAND GA
30528-7804
US

IV. Provider business mailing address

PO BOX 496
CLEVELAND GA
30528-0009
US

V. Phone/Fax

Practice location:
  • Phone: 706-865-3174
  • Fax: 706-865-4646
Mailing address:
  • Phone: 706-865-3174
  • Fax: 706-865-4646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12314
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: