Provider Demographics
NPI:1154140838
Name:SMALL, CRYSTAL R
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:R
Last Name:SMALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2293 PARK MANOR LN
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6844
Mailing Address - Country:US
Mailing Address - Phone:678-836-5280
Mailing Address - Fax:
Practice Address - Street 1:2293 PARK MANOR LN
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6844
Practice Address - Country:US
Practice Address - Phone:678-836-5280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion