Healthcare Provider Details

I. General information

NPI: 1053068874
Provider Name (Legal Business Name): ERIC STEVEN CROWSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 NORTHSIDE FORSYTH DR
CUMMING GA
30041-7659
US

IV. Provider business mailing address

1200 NORTHSIDE FORSYTH DR
CUMMING GA
30041-7659
US

V. Phone/Fax

Practice location:
  • Phone: 770-844-3396
  • Fax: 770-844-3397
Mailing address:
  • Phone: 770-844-3396
  • Fax: 770-844-3397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number024579
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: