Provider Demographics
NPI:1619608114
Name:FRAISER CRAWFORD, BRANDY KATHERINE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:KATHERINE
Last Name:FRAISER CRAWFORD
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:KATHERINE
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:160 BLUE LAKE ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-4435
Mailing Address - Country:US
Mailing Address - Phone:601-896-2102
Mailing Address - Fax:
Practice Address - Street 1:7130 HODGSON MEMORIAL DR STE 101
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-1527
Practice Address - Country:US
Practice Address - Phone:912-355-3881
Practice Address - Fax:912-335-3490
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN251862363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health