Provider Demographics
NPI:1558305706
Name:CRAWFORD, JESSICA N (PA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:N
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2171 NORTHLAKE PKWY
Mailing Address - Street 2:BUILDING 3, SUITE 100
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4104
Mailing Address - Country:US
Mailing Address - Phone:404-296-8000
Mailing Address - Fax:770-493-6842
Practice Address - Street 1:2171 NORTHLAKE PKWY
Practice Address - Street 2:BUILDING 3, SUITE 100
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4104
Practice Address - Country:US
Practice Address - Phone:404-296-8000
Practice Address - Fax:770-493-6842
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA004650363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical