Provider Demographics
NPI:1578754792
Name:CRAWFORD, JOHN CICERO II (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CICERO
Last Name:CRAWFORD
Suffix:II
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:80 JESSE HILL JR DR SE
Mailing Address - Street 2:GRADY MEMORIAL HOSPITAL
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303
Mailing Address - Country:US
Mailing Address - Phone:404-616-6867
Mailing Address - Fax:404-616-1973
Practice Address - Street 1:3941 JOHN HOPKINS CT
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-5709
Practice Address - Country:US
Practice Address - Phone:770-808-6054
Practice Address - Fax:404-616-1973
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
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Provider Licenses
StateLicense IDTaxonomies
GA001539363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical