Provider Demographics
NPI:1508989161
Name:CARLA CRAWFORD MD PC
Entity Type:Organization
Organization Name:CARLA CRAWFORD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:678-904-5211
Mailing Address - Street 1:PO BOX 1379
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-0033
Mailing Address - Country:US
Mailing Address - Phone:678-904-5211
Mailing Address - Fax:770-939-3331
Practice Address - Street 1:315 BOULEVARD NE
Practice Address - Street 2:SUITE 555
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1200
Practice Address - Country:US
Practice Address - Phone:678-904-5212
Practice Address - Fax:770-939-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA54479207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA563610431BMedicaid
GA563610431BMedicaid
GAGRP7257Medicare PIN