Healthcare Provider Details

I. General information

NPI: 1154351591
Provider Name (Legal Business Name): SHALIMAR SHEREE CROWE ATC/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 SPRING ST
ROYSTON GA
30662
US

IV. Provider business mailing address

491 CAREYTOWN RD
ROYSTON GA
30662-3304
US

V. Phone/Fax

Practice location:
  • Phone: 706-245-7226
  • Fax:
Mailing address:
  • Phone: 706-245-8657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT001020
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: