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Individual

CHRISTIE RAE CRUMP

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
367 CLEAR CREEK PKWY, LAVONIA, GA 30503-0658
(770) 219-7078
(770) 219-7365
Mailing address
PO BOX 658, GAINESVILLE, GA 30503-0658
(770) 718-1122
(770) 535-7445

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN155758
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01377753
AMERIGROUP
GA
05
222017877A
GA
05
222017877B
GA
05
222017877C
GA
05
222017877D
GA
05
222017877E
GA
01
567122
WELLCARE
GA
Enumeration date
09/09/2010
Last updated
09/05/2012
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