Provider Demographics
NPI:1538995766
Name:CRAWFORD, MARQUITTA (FNP)
Entity type:Individual
Prefix:
First Name:MARQUITTA
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 MONTICELLO ST SW
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2328
Mailing Address - Country:US
Mailing Address - Phone:770-939-9179
Mailing Address - Fax:770-621-3083
Practice Address - Street 1:1160 MONTICELLO ST SW
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2328
Practice Address - Country:US
Practice Address - Phone:770-939-9179
Practice Address - Fax:770-621-3083
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207397163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice