Provider Demographics
NPI:1457177974
Name:HYACINTH DENNIS CROOKS LLC
Entity type:Organization
Organization Name:HYACINTH DENNIS CROOKS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HYACINTH
Authorized Official - Middle Name:DENNIS-
Authorized Official - Last Name:CROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:404-432-5242
Mailing Address - Street 1:1046 JUSTICE LN NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-6351
Mailing Address - Country:US
Mailing Address - Phone:404-432-5242
Mailing Address - Fax:
Practice Address - Street 1:3772 CHEROKEE ST NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-2080
Practice Address - Country:US
Practice Address - Phone:404-432-5242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RED TENT WOMEN'S HEALTH AND MED SPA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-30
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service