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General NPI Number Information
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NPI Number | 1639263106
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Entity Type | Individual
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Provider Name | AUDREY SHIELDS CRUMBLEY M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 03/28/2019
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Provider Practice Location Address
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Address Line | 821 N. COBB ST.
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061
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Country | US
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Telephone | 478-454-3795
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Fax | 478-454-3969
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Provider Business Mailing Address
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Address Line | 213 O'CONNER DRIVE
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061
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Country | US
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Telephone | 478-454-5908
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 053031
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 053031
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License Number State | GA
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