Provider Demographics
NPI:1235286030
Name:CRAWFORD, CLIFFORD A (MD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:A
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1628 MARKET PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7927
Mailing Address - Country:US
Mailing Address - Phone:770-292-9982
Mailing Address - Fax:
Practice Address - Street 1:1628 MARKET PLACE BLVD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7927
Practice Address - Country:US
Practice Address - Phone:770-292-9982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13017207PP0204X
MI4301055324207PP0204X
GA058455207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine