Provider Demographics
NPI:1861670952
Name:CROWDER, MARY JANE (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JANE
Last Name:CROWDER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N RIVER ST NW
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-9408
Mailing Address - Country:US
Mailing Address - Phone:706-624-1444
Mailing Address - Fax:706-624-1450
Practice Address - Street 1:310 N RIVER ST NW
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-9408
Practice Address - Country:US
Practice Address - Phone:706-624-1444
Practice Address - Fax:706-624-1450
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN042132363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAS24709Medicare UPIN
GAGRP2154Medicare PIN