Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DN014377 | GA |
NPI | 1053683854 |
---|---|
Provider Name | Jimiesh G Crane |
First Address | Decatur, GA 30035-4000 |
Second Address | Decatur, GA 30035 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2012 |
Last Update Date | 15/05/2018 |