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General NPI Number Information
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NPI Number | 1417760927
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Entity Type | Individual
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Provider Name | TRAVIOUS CRENSHAW NP
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Gender | Male
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Dates
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Enumeration Date | 01/29/2025
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 3345 COBB PKWY NW
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City | ACWORTH
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State | GA
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Zip | 30101-3914
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Country | US
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Telephone | 678-919-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 1486 TERRELL MILL RD SE APT 265
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City | MARIETTA
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State | GA
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Zip | 30067-6103
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Country | US
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Telephone | 678-651-4424
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN-NP226257
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License Number State | GA
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