Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DN 011736 | GA |
NPI | 1023189206 |
---|---|
Provider Name | Mary Lynn Crews |
First Address | Decatur, GA 30033-3509 |
Second Address | Decatur, GA 30033-3509 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 08/07/2007 |