Healthcare Provider Details

I. General information

NPI: 1104662501
Provider Name (Legal Business Name): CRYSTAL DAWN MEADOWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2024
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 FRANKLIN SPRINGS ST
ROYSTON GA
30662-4134
US

IV. Provider business mailing address

1061 DOWDY RD STE 204
ATHENS GA
30606-5700
US

V. Phone/Fax

Practice location:
  • Phone: 706-621-7555
  • Fax: 706-621-7557
Mailing address:
  • Phone: 67-621-7555
  • Fax: 706-621-7557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN214029
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: