Individual
MRS. LYDIA CRENSHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CERT. HAIR LOSS SPEC
Contact information
Practice address
55 HEATON PLACE TRL, COVINGTON, GA 30016-0215
(678) 670-1787
Mailing address
1070 IRIS DR SW, CONYERS, GA 30094-5901
(678) 670-1787
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
CO090465
GA
Other
Enumeration date
09/21/2016
Last updated
09/21/2016
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