Provider Demographics
NPI:1013792852
Name:CRAWFORD, KIMBERLEY ANNE (PHD, MPH, RN, FNP-C)
Entity type:Individual
Prefix:DR
First Name:KIMBERLEY
Middle Name:ANNE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PHD, MPH, RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 4TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-2724
Mailing Address - Country:US
Mailing Address - Phone:404-371-9407
Mailing Address - Fax:
Practice Address - Street 1:3700 MARKET ST STE E-1
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021-2653
Practice Address - Country:US
Practice Address - Phone:678-898-5731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN139443363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily