Provider Demographics
NPI:1588214407
Name:HOSEY, CRYSTAL J
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:J
Last Name:HOSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 BABBLING BRK NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-7975
Mailing Address - Country:US
Mailing Address - Phone:404-228-9166
Mailing Address - Fax:404-500-4286
Practice Address - Street 1:1817 BABBLING BRK NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-7975
Practice Address - Country:US
Practice Address - Phone:404-228-9166
Practice Address - Fax:404-500-4286
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-R-0961251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health