Provider Demographics
NPI:1417272022
Name:CROWE, JOHN RICHARD (LPN)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RICHARD
Last Name:CROWE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 MAIN ST W
Mailing Address - Street 2:
Mailing Address - City:MARSHALLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31057-9731
Mailing Address - Country:US
Mailing Address - Phone:478-967-1130
Mailing Address - Fax:
Practice Address - Street 1:307 MAIN ST W
Practice Address - Street 2:
Practice Address - City:MARSHALLVILLE
Practice Address - State:GA
Practice Address - Zip Code:31057-9731
Practice Address - Country:US
Practice Address - Phone:478-967-1130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN052633103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst