Provider Demographics
NPI:1881019305
Name:HANCOCK, CRYSTAL L (NP)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:L
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12978 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30752
Mailing Address - Country:US
Mailing Address - Phone:706-657-4183
Mailing Address - Fax:706-657-4270
Practice Address - Street 1:12978 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:GA
Practice Address - Zip Code:30752
Practice Address - Country:US
Practice Address - Phone:706-657-4183
Practice Address - Fax:706-657-4270
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN213708363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily