Provider Demographics
NPI:1356315709
Name:CRABTREE, STEPHEN A (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:CRABTREE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 S LEE ST
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3072
Mailing Address - Country:US
Mailing Address - Phone:770-410-9116
Mailing Address - Fax:
Practice Address - Street 1:4330 S LEE ST
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3072
Practice Address - Country:US
Practice Address - Phone:770-410-9116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052548207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA198020OtherBCBS OF GEORGIA
GA746575587CMedicaid
GA746575587Medicaid
GA333401OtherWELLCARE OF GEORGIA
GA11099OtherKAISER
GA746575587BMedicaid
GA10038111OtherAMERIGROUP
GA196610OtherBCBS OF GEOGIA
GA746575587CMedicaid
GA746575587Medicaid
GA11099OtherKAISER
GA746575587BMedicaid