Provider Demographics
NPI:1467445593
Name:CRAWLEY-MATAOSKY, DEBRA L (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:CRAWLEY-MATAOSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 807
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-0807
Mailing Address - Country:US
Mailing Address - Phone:478-237-2638
Mailing Address - Fax:478-237-9138
Practice Address - Street 1:316 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-3535
Practice Address - Country:US
Practice Address - Phone:478-237-2638
Practice Address - Fax:478-237-9138
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033573207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111814OtherUGS-WARRENTON
GA111889OtherUGS-SOPERTON
08BDFLSOtherMEDICARE FFS
GA111811OtherUGS-SPARTA
GA111830OtherUGS-SWAINSBORO
GA111812OtherUGS-GIBSON
GA111813OtherUGS-CRAWFORDVILLE
GA111887OtherUGS REIDSVILLE
E82459Medicare UPIN