Healthcare Provider Details

I. General information

NPI: 1821365214
Provider Name (Legal Business Name): MARVA CROSBY DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2011
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 WASHINGTON AVE
EAST POINT GA
30344-4115
US

IV. Provider business mailing address

1003 AUGUSTA DR SE
MARIETTA GA
30067-8208
US

V. Phone/Fax

Practice location:
  • Phone: 404-767-7474
  • Fax: 404-767-7707
Mailing address:
  • Phone: 678-355-9072
  • Fax: 678-355-9072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCHIRO08750
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: