Provider Demographics
NPI:1548409097
Name:LOVVORN, CRYSTAL HARRIS (PA-C)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:HARRIS
Last Name:LOVVORN
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 1:200 ALLEN MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:GA
Mailing Address - Zip Code:30110-2012
Mailing Address - Country:US
Mailing Address - Phone:770-824-2000
Mailing Address - Fax:
Practice Address - Street 1:200 ALLEN MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:GA
Practice Address - Zip Code:30110-2012
Practice Address - Country:US
Practice Address - Phone:770-824-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant