=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497766844
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | S. JEFFREY CREWS, DMD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 317 REDMOND RD NW
-----------------------------------------------------
City | ROME
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30165-1539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-291-2901
-----------------------------------------------------
Fax | 706-291-7023
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 317 REDMOND RD NW
-----------------------------------------------------
City | ROME
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30165-1539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-291-2901
-----------------------------------------------------
Fax | 706-291-7023
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. STEPHEN JEFFREY CREWS
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 706-291-2901
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | DN008939
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------