MEDICARE: JAIMEE LEE CRUMPLER

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
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1477481893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIMEE LEE CRUMPLER

Provider Business Mailing Address
First Line	:	645 STONEVIEW DR
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30115-0202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 PILGRIM VILLAGE DR STE 200
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-2583
Country	:	US
Telephone Number	:	678-395-3269
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/13/2026

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