Individual
DR. JACK CREWS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 PROFESSIONAL PL, SUITE 204, CARROLLTON, GA 30117-3874
(770) 384-3351
Mailing address
100 PROFESSIONAL PL, SUITE 204, CARROLLTON, GA 30117-3874
(770) 384-3351
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
010514
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00677201A
—
GA
01
—
552328
BLUE CROSS
GA
Enumeration date
11/02/2005
Last updated
07/09/2007
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