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General NPI Number Information
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NPI Number | 1578754792
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Entity Type | Individual
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Provider Name | JOHN CICERO CRAWFORD II P.A.-C
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Gender | Male
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 08/05/2007
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Provider Practice Location Address
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Address Line | 3941 JOHN HOPKINS CT
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City | DECATUR
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State | GA
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Zip | 30034-5709
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Country | US
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Telephone | 770-808-6054
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Fax | 404-616-1973
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Provider Business Mailing Address
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Address Line | 80 JESSE HILL JR DR SE GRADY MEMORIAL HOSPITAL
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City | ATLANTA
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State | GA
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Zip | 30303
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Country | US
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Telephone | 404-616-6867
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Fax | 404-616-1973
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 001539
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License Number State | GA
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