Provider Demographics
NPI:1396198925
Name:CROWLEY, CANDACE (RD)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:CROWLEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 WOODVALE CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-1919
Mailing Address - Country:US
Mailing Address - Phone:513-508-0731
Mailing Address - Fax:
Practice Address - Street 1:5475 CHAMBLEE DUNWOODY RD
Practice Address - Street 2:#880
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-4114
Practice Address - Country:US
Practice Address - Phone:678-379-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004684133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered