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General NPI Number Information
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NPI Number | 1376028944
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Entity Type | Individual
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Provider Name | ANTHONY MARK CROSSLEY
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Gender | Male
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Dates
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Enumeration Date | 09/30/2018
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Last Update Date | 09/30/2018
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Provider Practice Location Address
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Address Line | 4321 S LEE ST
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City | BUFORD
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State | GA
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Zip | 30518-5776
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Country | US
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Telephone | 678-565-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 4321 S LEE ST
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City | BUFORD
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State | GA
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Zip | 30518-5776
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Country | US
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Telephone | 678-565-6500
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Fax |
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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 | 372600000X
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Taxonomy Name | Adult Companion
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License Number | 067-R-1624
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | 067-R-1624
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 372500000X
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Taxonomy Name | Chore Provider
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License Number | 056-R-1624
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 067-R-1624
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 067-R-1624
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License Number State | GA
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