Provider Demographics
NPI:1184746158
Name:CRUDGINGTON, RACHEL ANN (MD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANN
Last Name:CRUDGINGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ANN
Other - Last Name:CAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-533-4786
Practice Address - Street 1:725 JESSE JEWELL PKWY SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3834
Practice Address - Country:US
Practice Address - Phone:770-535-3611
Practice Address - Fax:770-535-7092
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060718208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA178218352BMedicaid
GA530894OtherWELLCARE
GA178218352CMedicaid
GA453382OtherWELLCARE
GA8974812OtherCIGNA
GA178218352AMedicaid
GA178218352DMedicaid
GA178218352EMedicaid
GA453415OtherWELLCARE
GA9806158OtherAETNA
GA582117020OtherTRICARE
GA582117020024OtherTRICARE
GA01184316OtherAMERIGROUP
GA453429OtherWELLCARE
GA582117020018OtherTRICARE
GA582117020030OtherTRICARE
GA453425OtherWELLCARE
GA52245265OtherBCBS
GA178218352EMedicaid