Provider Demographics
NPI:1427669324
Name:EMORY, CRYSTAL ANNETTE
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ANNETTE
Last Name:EMORY
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 1:2311 DEERFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-4500
Mailing Address - Country:US
Mailing Address - Phone:864-978-9590
Mailing Address - Fax:
Practice Address - Street 1:2311 DEERFIELD WAY
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-4500
Practice Address - Country:US
Practice Address - Phone:864-978-9590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker