Individual
DR. CRYSTAL LENAY MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
677 CHURCH ST NE, MARIETTA, GA 30060-1101
(770) 794-0477
Mailing address
1314 VALLEY VIEW RD, ATLANTA, GA 30338-4823
(313) 641-9942
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN258358
GA
367500000X
Certified Registered Nurse Anesthetist
Primary
RN258368
GA
Other
Enumeration date
07/13/2021
Last updated
10/14/2021
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