Healthcare Provider Details

I. General information

NPI: 1952236366
Provider Name (Legal Business Name): ALEXANDER OLDHAM CRENSHAW PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 SUN VALLEY DR STE M2
ROSWELL GA
30076-5631
US

IV. Provider business mailing address

183 GOLDEN BANNER AVE
MARIETTA GA
30060-2334
US

V. Phone/Fax

Practice location:
  • Phone: 678-381-1687
  • Fax:
Mailing address:
  • Phone: 513-907-9104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY900258
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: