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General NPI Number Information
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NPI Number | 1255325536
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Entity Type | Individual
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Provider Name | MARTHA H CRENSHAW MD
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Gender | Female
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Dates
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Enumeration Date | 09/01/2005
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Last Update Date | 02/17/2010
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Provider Practice Location Address
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Address Line | 1805 PARKE PLAZA CIR SUITE 101
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-3498
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Country | US
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Telephone | 770-469-7000
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Fax | 770-879-0436
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Provider Business Mailing Address
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Address Line | 1805 PARKE PLAZA CIR SUITE 101
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-3498
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Country | US
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Telephone | 770-469-7000
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Fax | 770-879-0436
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 023580
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License Number State | GA
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