Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN006726 | GA |
NPI | 1003928698 |
---|---|
Provider Name | Jerry L Crawford |
First Address | Athens, GA 30606-2242 |
Second Address | Athens, GA 30606-2242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |