Provider Demographics
NPI:1639104276
Name:MCCRANIE, ROCHELLE G (PA)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:G
Last Name:MCCRANIE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2876
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31776-2876
Mailing Address - Country:US
Mailing Address - Phone:229-891-9016
Mailing Address - Fax:229-891-9185
Practice Address - Street 1:8 LAUREL CT
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6889
Practice Address - Country:US
Practice Address - Phone:229-890-9016
Practice Address - Fax:229-891-9185
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA003064363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA530785199BMedicaid
GA396284OtherWELLCARE MEDICAID
GA132996OtherPEACHSTATE MEDICAID