Provider Demographics
NPI:1891283115
Name:CROFT, LYNDY
Entity Type:Individual
Prefix:
First Name:LYNDY
Middle Name:
Last Name:CROFT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 CHARLES HARDY PKWY UNIT C
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-1836
Mailing Address - Country:US
Mailing Address - Phone:789-458-2006
Mailing Address - Fax:
Practice Address - Street 1:176 CHARLES HARDY PKWY UNIT C
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-1836
Practice Address - Country:US
Practice Address - Phone:678-945-8200
Practice Address - Fax:678-945-8209
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN181601163WE0003X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency