Provider Demographics
NPI:1851460786
Name:BRIGHT, CRYSTAL D (MD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:D
Last Name:BRIGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 48089
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-8089
Mailing Address - Country:US
Mailing Address - Phone:706-389-3740
Mailing Address - Fax:706-389-3951
Practice Address - Street 1:355 CLEAR CREEK PKWY STE 1003
Practice Address - Street 2:
Practice Address - City:LAVONIA
Practice Address - State:GA
Practice Address - Zip Code:30553-4271
Practice Address - Country:US
Practice Address - Phone:706-356-1422
Practice Address - Fax:706-356-1425
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA67869207QS0010X, 207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003125816AMedicaid