MEDICARE: ALISSA RUTH CROWE

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	390200000X	Student in an Organized Health Care Education/Training Program
2	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1538740907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISSA RUTH CROWE

Provider Business Mailing Address
First Line	:	1970 STERLING CREEK CT
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-2995
Country	:	US
Telephone Number	:	404-918-1004
Fax Number	:

Provider Business Practice Location Address
First Line	:	1970 STERLING CREEK CT
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-2995
Country	:	US
Telephone Number	:	404-918-1004
Fax Number	:

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

Provider Enumeration Date	:	04/17/2021
Last Update Date	:	05/21/2023

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Directions to “ ALISSA RUTH CROWE ” Practice Location

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