MEDICARE: ANDREA LEAH CROWELL

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	2084P0800X	Psychiatry Physician	68497	GA

General Provider Information

NPI Number	:	1770809626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA LEAH CROWELL

Provider Business Mailing Address
First Line	:	931 PONCE DE LEON AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-4211
Country	:	US
Telephone Number	:	678-379-9576
Fax Number	:

Provider Business Practice Location Address
First Line	:	931 PONCE DE LEON AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-4211
Country	:	US
Telephone Number	:	678-379-9576
Fax Number	:

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

Provider Enumeration Date	:	04/18/2010
Last Update Date	:	01/28/2026

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