Provider Demographics
NPI:1902823784
Name:CRAWFORD, CARLA E (MD)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:E
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 76104
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30358-1104
Mailing Address - Country:US
Mailing Address - Phone:678-904-5211
Mailing Address - Fax:678-904-5212
Practice Address - Street 1:5400 LAUREL SPRINGS PARKWAYS
Practice Address - Street 2:BLDG 1400 SUITE 1403
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-0000
Practice Address - Country:US
Practice Address - Phone:678-904-5211
Practice Address - Fax:678-904-5212
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054479207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA16BBCTSMedicare PIN
G62986Medicare UPIN