Provider Demographics
NPI:1477378875
Name:CRAWFORD LONG HOSPITAL
Entity type:Organization
Organization Name:CRAWFORD LONG HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:AVA
Authorized Official - Middle Name:E
Authorized Official - Last Name:DAUNT-SAMFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-686-4918
Mailing Address - Street 1:550 PEACHTREE ST NE STE 6.5P30
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2247
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 PEACHTREE ST NE STE 6.5P30
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2247
Practice Address - Country:US
Practice Address - Phone:404-686-5020
Practice Address - Fax:404-686-3927
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRAWFORD LONG HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPHHH000081OtherGEORGIA BOARD OF PHARMACY