Provider Demographics
NPI:1245963669
Name:CREW CONSULTING SERVICES LLC
Entity type:Organization
Organization Name:CREW CONSULTING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:CREW
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:706-338-5544
Mailing Address - Street 1:200 SUDDETH ST
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30683-1901
Mailing Address - Country:US
Mailing Address - Phone:706-338-5544
Mailing Address - Fax:706-995-6865
Practice Address - Street 1:200 SUDDETH ST
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30683-1901
Practice Address - Country:US
Practice Address - Phone:706-338-5544
Practice Address - Fax:706-995-6865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-04
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003225221AMedicaid
GA003240189AMedicaid