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NPI Code Detail

MEDICARE: MARK ANDREW CROSSEN LMSW

MEDICARE: MARK ANDREW CROSSEN LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerMSW009757GA

General Provider Information

NPI Number : 1265180897
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK ANDREW CROSSEN LMSW
Provider Business Mailing Address
First Line : 1121 JOHNSON FERRY RD STE 450
Second Line :
City : MARIETTA
State : GA
Zip : 30068-5433
Country : US
Telephone Number : 770-694-6349
Fax Number :
Provider Business Practice Location Address
First Line : 1121 JOHNSON FERRY RD STE 450
Second Line :
City : MARIETTA
State : GA
Zip : 30068-5433
Country : US
Telephone Number : 770-694-6349
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2022
Last Update Date : 11/05/2022

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Directions to “ MARK ANDREW CROSSEN LMSW” Practice Location

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