Provider Demographics
NPI:1235308909
Name:SEN, CRYSTAL CLARK (PA-C, MMSC)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:CLARK
Last Name:SEN
Suffix:
Gender:F
Credentials:PA-C, MMSC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6600 PEACHTREE DUNWOODY RD BLD 600, STE 325
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328
Mailing Address - Country:US
Mailing Address - Phone:404-876-1906
Mailing Address - Fax:404-256-8506
Practice Address - Street 1:3400 OLD MILTON PKWY STE C500
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005
Practice Address - Country:US
Practice Address - Phone:678-775-2284
Practice Address - Fax:678-775-2285
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA005269363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical