Provider Demographics
NPI:1780842633
Name:CRYDER, JEFFREY ELLIOTT (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ELLIOTT
Last Name:CRYDER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 MASON PHILIP DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31216-7366
Mailing Address - Country:US
Mailing Address - Phone:706-319-7470
Mailing Address - Fax:
Practice Address - Street 1:179 MASON PHILIP DRIVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31216-7366
Practice Address - Country:US
Practice Address - Phone:706-319-7470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN166777367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA812134122AMedicaid
GA812134122BMedicaid
GAP00605496Medicare PIN
GA812134122AMedicaid