Individual
DR. DEIDRE DENISE CROCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2390 WALL ST SE, CONYERS, GA 30013-2150
(770) 922-5696
(770) 922-1065
Mailing address
2390 WALL ST SE, CONYERS, GA 30013-2150
(770) 922-5696
(770) 922-1065
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
056811
GA
208000000X
Pediatrics Physician
056811
GA
2083P0901X
Public Health & General Preventive Medicine Physician
056811
GA
Other
Enumeration date
06/26/2008
Last updated
11/10/2011
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