Provider Demographics
NPI:1063702124
Name:CROOK, MOLLY LATIMER (NP)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:LATIMER
Last Name:CROOK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8 PALM GROVE CT
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-3023
Mailing Address - Country:US
Mailing Address - Phone:912-356-1515
Mailing Address - Fax:912-644-0756
Practice Address - Street 1:5356 REYNOLDS ST
Practice Address - Street 2:STE 505
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6016
Practice Address - Country:US
Practice Address - Phone:912-356-1515
Practice Address - Fax:912-644-0756
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN178137163W00000X
GARN178137 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I509015Medicare PIN