Provider Demographics
NPI:1396002150
Name:CRAWFORD, AMELIA TAYLOR (PA-C)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:TAYLOR
Last Name:CRAWFORD
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 1:2210 LAURENS RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3224
Mailing Address - Country:US
Mailing Address - Phone:864-288-8289
Mailing Address - Fax:
Practice Address - Street 1:2210 LAURENS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3224
Practice Address - Country:US
Practice Address - Phone:864-288-8289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2012363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003124825DMedicaid
GA691178OtherWELLCARE
GAP01118233OtherRAILROAD MEDICARE
GAP01064190OtherRAILROAD MEDICARE
GA003124825BMedicaid
GA003124825AMedicaid
GA003124825EMedicaid
GAP01118233OtherRAILROAD MEDICARE
GA691178OtherWELLCARE