Individual
MARK A CRUMP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
708 S 8TH ST, GRIFFIN, GA 30224-4827
(770) 228-5402
(770) 412-6917
Mailing address
708 S 8TH ST, GRIFFIN, GA 30224-4827
(770) 228-5402
(770) 412-6917
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
28957
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000332758A
—
GA
01
—
581936002
TAX ID
GA
Enumeration date
08/09/2005
Last updated
09/26/2019
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