Provider Demographics
NPI:1699730705
Name:CRISPIN, MARK E (MD)
Entity type:Individual
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First Name:MARK
Middle Name:E
Last Name:CRISPIN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5673 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:STE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-257-0064
Mailing Address - Fax:404-257-1568
Practice Address - Street 1:5673 PEACHTREE DUNWOODY RD
Practice Address - Street 2:STE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-257-0064
Practice Address - Fax:404-257-1568
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2022-06-09
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Provider Licenses
StateLicense IDTaxonomies
GA0321632086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F03567Medicare UPIN