Individual
JODY CHRISTOPHER CRISWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
3647 J DEWEY GRAY CIR STE 200, AUGUSTA, GA 30909-2205
(706) 504-9712
(706) 504-9703
Mailing address
PO BOX 3726, AUGUSTA, GA 30914-3726
(706) 863-9595
(706) 868-8375
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN194462
GA
363LA2100X
Acute Care Nurse Practitioner
RN194462
GA
Other
Enumeration date
07/21/2019
Last updated
02/24/2020
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