Provider Demographics
NPI:1326551136
Name:BISHOP, CRYSTAL M (PA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:M
Last Name:BISHOP
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:M
Other - Last Name:HAMRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:
Practice Address - Street 1:1330 BOILING SPRINGS RD STE 1600
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-4219
Practice Address - Country:US
Practice Address - Phone:864-582-6396
Practice Address - Fax:864-582-1608
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-15
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2882363A00000X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP02302275OtherRAILROAD MEDICARE