Provider Demographics
NPI:1922499474
Name:LECRAW, EMILY BROCK (PA-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:BROCK
Last Name:LECRAW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:95 COLLIER RD NW STE 6015
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1750
Mailing Address - Country:US
Mailing Address - Phone:404-351-5959
Mailing Address - Fax:404-351-8526
Practice Address - Street 1:95 COLLIER RD NW STE 6015
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1750
Practice Address - Country:US
Practice Address - Phone:404-351-5959
Practice Address - Fax:404-351-8526
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2018-02-14
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant