Provider Demographics
NPI:1881974723
Name:CRAWFORD, MARY ALICE
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:ALICE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1147 HERMAN LODGE BLVD
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30830-7622
Mailing Address - Country:US
Mailing Address - Phone:706-836-1652
Mailing Address - Fax:
Practice Address - Street 1:1147 HERMAN LODGE BLVD
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:GA
Practice Address - Zip Code:30830-7622
Practice Address - Country:US
Practice Address - Phone:706-836-1652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator