Provider Demographics
NPI:1891016846
Name:WELCH, CRYSTAL LAVETTE (MD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LAVETTE
Last Name:WELCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:WELCH
Other - Last Name:GOODMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4351 COOPER OAKS DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-4765
Mailing Address - Country:US
Mailing Address - Phone:404-423-8132
Mailing Address - Fax:770-702-0570
Practice Address - Street 1:1800 PEACHTREE ST NW STE 500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2509
Practice Address - Country:US
Practice Address - Phone:770-702-0101
Practice Address - Fax:770-702-0570
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA72480207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology