MEDICARE: DR. FLORENCE R LECRAW M.D

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	207L00000X	Anesthesiology Physician	033222	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00362500	OTHER	GA	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	20-02624	OTHER	GA	UNITED HEALTHCARE
3	52576387-009	OTHER	GA	BLUE CROSS BLUE SHIELD
5	156961100	OTHER	GA	U.S. DEPT. OF LABOR
6	N359526	OTHER	GA	WELLCARE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	52576387	OTHER	GA	BCBS OF GA
10	9975585	OTHER	GA	UNIVERSAL HEALTHCARE

General Provider Information

NPI Number	:	1588687289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FLORENCE R LECRAW M.D

Provider Business Mailing Address
First Line	:	222 12TH ST NE
Second Line	:	UNIT 2007
City	:	ATLANTA
State	:	GA
Zip	:	30309-4001
Country	:	US
Telephone Number	:	404-234-8244
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 BALTIMORE PL NW
Second Line	:	SUITE 400
City	:	ATLANTA
State	:	GA
Zip	:	30308-2116
Country	:	US
Telephone Number	:	404-885-9675
Fax Number	:	404-759-2212

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	06/11/2015

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