Provider Demographics
NPI:1336732072
Name:CRUMP, DONALD (PTA)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:
Last Name:CRUMP
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6851 ROSWELL RD APT Q29
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-2492
Mailing Address - Country:US
Mailing Address - Phone:404-784-2710
Mailing Address - Fax:
Practice Address - Street 1:6851 ROSWELL RD APT Q29
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-2492
Practice Address - Country:US
Practice Address - Phone:404-434-0911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-13
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA004619208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA182278OtherPIN #