Provider Demographics
NPI:1700419926
Name:WHITFIELD, LAURA ALYSSA CREW (NP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ALYSSA CREW
Last Name:WHITFIELD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ALYSSA CLAYTON
Other - Last Name:CREW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 12938
Mailing Address - Street 2:C/O CLINIC MANAGEMENT
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703
Mailing Address - Country:US
Mailing Address - Phone:706-602-7800
Mailing Address - Fax:
Practice Address - Street 1:21 COMMERCE PKWY
Practice Address - Street 2:
Practice Address - City:ADAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30103-2009
Practice Address - Country:US
Practice Address - Phone:770-773-9201
Practice Address - Fax:770-773-9219
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN249030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily