=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427669670
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CRAWFORD LONG HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2020
-----------------------------------------------------
Last Update Date | 11/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 PEACHTREE ST NE STE 1760
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30308-2262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-686-5020
-----------------------------------------------------
Fax | 404-686-3927
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 550 PEACHTREE ST NE STE 1760
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30308-2262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-686-5020
-----------------------------------------------------
Fax | 404-686-3927
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HOSPITAL CFO
-----------------------------------------------------
Name | GREG ANDERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 404-686-2823
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------