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General NPI Number Information
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NPI Number | 1760006399
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Entity Type | Individual
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Provider Name | CRYSTAL DETCHEMENDY RN
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Gender | Female
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Dates
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Enumeration Date | 05/29/2020
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Last Update Date | 09/29/2026
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Provider Practice Location Address
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Address Line | 3232 SKINNER MILL RD
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City | AUGUSTA
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State | GA
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Zip | 30909-1970
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Country | US
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Telephone | 803-341-5292
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Fax |
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Provider Business Mailing Address
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Address Line | 1465 LANEY WALKER BLVD PAVILION II; AF 1040
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City | AUGUSTA
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State | GA
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Zip | 30912-0001
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Country | US
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Telephone | 706-721-9745
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN240890
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License Number State | GA
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