Provider Demographics
NPI:1720467715
Name:TODD-CROOKS, SEAN
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:TODD-CROOKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3881 ERICA CIR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-4117
Mailing Address - Country:US
Mailing Address - Phone:678-653-2411
Mailing Address - Fax:800-934-8987
Practice Address - Street 1:3881 ERICA CIR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-4117
Practice Address - Country:US
Practice Address - Phone:678-653-2411
Practice Address - Fax:800-934-8987
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies