Provider Demographics
NPI:1235190042
Name:ASCHE CROWE, PEARL ESTELLA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:PEARL
Middle Name:ESTELLA
Last Name:ASCHE CROWE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 COUNTRY CLUB DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7344
Mailing Address - Country:US
Mailing Address - Phone:770-474-3882
Mailing Address - Fax:770-474-9392
Practice Address - Street 1:150 COUNTRY CLUB DR
Practice Address - Street 2:SUITE 100
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7344
Practice Address - Country:US
Practice Address - Phone:770-474-3882
Practice Address - Fax:770-474-9392
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002203363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA042927832AMedicaid
GAS51860Medicare UPIN
GA042927832AMedicaid