Provider Demographics
NPI:1134436322
Name:CRUMP, CHRISTIE RAE (NP)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:RAE
Last Name:CRUMP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:RAE
Other - Last Name:SELLERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:367 CLEAR CREEK PKWY
Practice Address - Street 2:
Practice Address - City:LAVONIA
Practice Address - State:GA
Practice Address - Zip Code:30503-0658
Practice Address - Country:US
Practice Address - Phone:770-219-7078
Practice Address - Fax:770-219-7365
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN155758363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA567122OtherWELLCARE
GA222017877CMedicaid
GA222017877BMedicaid
GA222017877EMedicaid
GA01377753OtherAMERIGROUP
GA222017877AMedicaid
GA222017877DMedicaid
GA222017877BMedicaid