Provider Demographics
NPI:1982930699
Name:CROWDER, CRYSTAL (PA-C, ATC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:CROWDER
Suffix:
Gender:F
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 WHITE PINE WAY
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36869-7983
Mailing Address - Country:US
Mailing Address - Phone:254-681-2539
Mailing Address - Fax:
Practice Address - Street 1:2292 PEACHTREE RD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1147
Practice Address - Country:US
Practice Address - Phone:404-996-0120
Practice Address - Fax:404-351-6762
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
GA11127363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical