Healthcare Provider Details

I. General information

NPI: 1831242544
Provider Name (Legal Business Name): CRYSTAL ANN PRESTON-LLOYD NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 W 3RD ST STE A
JACKSON GA
30233-1979
US

IV. Provider business mailing address

PO BOX 746765
ATLANTA GA
30374-6765
US

V. Phone/Fax

Practice location:
  • Phone: 770-914-0116
  • Fax: 770-995-4278
Mailing address:
  • Phone: 770-814-0116
  • Fax: 770-995-4278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP126112
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN126112
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: