Provider Demographics
NPI:1023551884
Name:CRAWFORD, STACY
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:CRAWFORD
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 1:795 PATRIOT PKWY
Mailing Address - Street 2:208
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-2336
Mailing Address - Country:US
Mailing Address - Phone:404-430-9251
Mailing Address - Fax:
Practice Address - Street 1:795 PATRIOT PKWY
Practice Address - Street 2:208
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-2336
Practice Address - Country:US
Practice Address - Phone:404-430-9251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343800000X, 172V00000X, 3747P1801X
SCP45203164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No172V00000XOther Service ProvidersCommunity Health Worker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant