Healthcare Provider Details

I. General information

NPI: 1295993194
Provider Name (Legal Business Name): CRAWFORD PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 ACWORTH DUE WEST RD NW STE 220
KENNESAW GA
30144-1001
US

IV. Provider business mailing address

3450 ACWORTH DUE WEST RD NW STE 220
KENNESAW GA
30144-1001
US

V. Phone/Fax

Practice location:
  • Phone: 770-794-6643
  • Fax: 770-618-9617
Mailing address:
  • Phone: 770-794-6643
  • Fax: 770-794-6683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number058734
License Number StateGA

VIII. Authorized Official

Name: DR. MARCUS H CRAWFORD
Title or Position: CEO/OWNER
Credential: M.D.
Phone: 770-794-6643