Provider Demographics
NPI:1902841307
Name:CROWLEY, NANNETTE RENE (MD)
Entity Type:Individual
Prefix:
First Name:NANNETTE
Middle Name:RENE
Last Name:CROWLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 HARDEMAN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-1470
Mailing Address - Country:US
Mailing Address - Phone:478-742-3704
Mailing Address - Fax:478-741-7251
Practice Address - Street 1:1508 HARDEMAN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1470
Practice Address - Country:US
Practice Address - Phone:478-742-3704
Practice Address - Fax:478-741-7251
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052700207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI53815Medicare UPIN