MEDICARE: RONNI MARIE CRAWFORD

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	106S00000X	Behavior Technician	RBT-24-353816	GA

General Provider Information

NPI Number	:	1609739150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONNI MARIE CRAWFORD

Provider Business Mailing Address
First Line	:	1851 MARKET ST STE 109
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30135-3135
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 JOSEPH E LOWERY BLVD NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30314-3422
Country	:	US
Telephone Number	:	470-887-7673
Fax Number	:

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

Provider Enumeration Date	:	12/03/2025
Last Update Date	:	12/03/2025

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Directions to “ RONNI MARIE CRAWFORD ” Practice Location

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