Healthcare Provider Details

I. General information

NPI: 1366073454
Provider Name (Legal Business Name): REBECCA G. CROWE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 PROVIDENCE CIR
STATHAM GA
30666-2131
US

IV. Provider business mailing address

516 PROVIDENCE CIR
STATHAM GA
30666-2131
US

V. Phone/Fax

Practice location:
  • Phone: 404-931-6488
  • Fax:
Mailing address:
  • Phone: 404-931-6488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: