Individual
BENNIE EDWARD CRUDUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
440 WINN WAY, RM 2118, DECATUR, GA 30030-1715
(404) 508-7857
(404) 508-7826
Mailing address
440 WINN WAY, RM 2118, DECATUR, GA 30030-1715
(404) 508-7857
(404) 508-7826
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN067878
GA
Other
Enumeration date
04/06/2007
Last updated
07/08/2007
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