Provider Demographics
NPI:1154574689
Name:CROUCH, ANNE CARSON (PA-C)
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:CARSON
Last Name:CROUCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 116510
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-6073
Mailing Address - Country:US
Mailing Address - Phone:912-355-6615
Mailing Address - Fax:912-351-0645
Practice Address - Street 1:8880 ABERCORN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4508
Practice Address - Country:US
Practice Address - Phone:912-331-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5623363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003114220BMedicaid
SCP00727253OtherRAILROAD MEDICARE ID-RSFPN