Healthcare Provider Details

I. General information

NPI: 1740154616
Provider Name (Legal Business Name): BRITTANY CRENSHAW CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/02/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 POPLAR RD
NEWNAN GA
30265-1618
US

IV. Provider business mailing address

1559 WILLIAMSON RD STE F
GRIFFIN GA
30224-4057
US

V. Phone/Fax

Practice location:
  • Phone: 770-400-1000
  • Fax:
Mailing address:
  • Phone: 770-712-5972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number194407
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: