Provider Demographics
NPI:1639321920
Name:CROSBY, STEPHEN BENJAMIN (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:BENJAMIN
Last Name:CROSBY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY MEDICAL GROUP, LLC
Mailing Address - Street 2:PO BOX 1705
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-1705
Mailing Address - Country:US
Mailing Address - Phone:706-854-6917
Mailing Address - Fax:706-774-7279
Practice Address - Street 1:840 STEVENS CREEK ROAD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907
Practice Address - Country:US
Practice Address - Phone:706-722-6957
Practice Address - Fax:706-722-7454
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005461363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant