Provider Demographics
NPI:1821260340
Name:JOHN J. CRUMPTON DMD, P.C.
Entity Type:Organization
Organization Name:JOHN J. CRUMPTON DMD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:DRAWDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-865-0357
Mailing Address - Street 1:1018 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528-1419
Mailing Address - Country:US
Mailing Address - Phone:706-865-0357
Mailing Address - Fax:706-348-1828
Practice Address - Street 1:1018 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:GA
Practice Address - Zip Code:30528-1419
Practice Address - Country:US
Practice Address - Phone:706-865-0357
Practice Address - Fax:706-348-1828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0123141223G0001X
GADN0096721223G0001X
GADN0094441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA664016008LMedicaid
GA000936823BMedicaid
GA000379398LMedicaid