Provider Demographics
NPI:1154975647
Name:CRAWFORD, PRESTON ALLEN (NP-C)
Entity type:Individual
Prefix:
First Name:PRESTON
Middle Name:ALLEN
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 JOE NORMAN RD
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31539-8047
Mailing Address - Country:US
Mailing Address - Phone:912-278-2303
Mailing Address - Fax:
Practice Address - Street 1:11 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:GA
Practice Address - Zip Code:31539-6243
Practice Address - Country:US
Practice Address - Phone:800-367-0816
Practice Address - Fax:912-525-1933
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN239193207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine