Provider Demographics
NPI:1770787582
Name:CRAWFORD, MARCUS H (MD)
Entity type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:H
Last Name:CRAWFORD
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3450 ACWORTH DUE WEST ROAD
Mailing Address - Street 2:BUILDING 200, SUITE 220
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144
Mailing Address - Country:US
Mailing Address - Phone:770-794-6643
Mailing Address - Fax:770-794-6683
Practice Address - Street 1:3450 ACWORTH DUE WEST ROAD
Practice Address - Street 2:BUILDING 200, SUITE 220
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144
Practice Address - Country:US
Practice Address - Phone:770-794-6643
Practice Address - Fax:770-794-6683
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2015-07-17
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Provider Licenses
StateLicense IDTaxonomies
GA058734208200000X
GA58734208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA721385595AMedicaid
GA511G240001Medicare PIN