Provider Demographics
NPI:1639263106
Name:CRUMBLEY, AUDREY SHIELDS (MD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:SHIELDS
Last Name:CRUMBLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 O'CONNER DRIVE
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061
Mailing Address - Country:US
Mailing Address - Phone:478-454-5908
Mailing Address - Fax:
Practice Address - Street 1:821 N. COBB ST.
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061
Practice Address - Country:US
Practice Address - Phone:478-454-3795
Practice Address - Fax:478-454-3969
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053031207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA429736064DMedicaid
GA93BFBWQMedicare ID - Type Unspecified