Individual
ANTEQUA CRUMLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
105 ROSEMONT CT, ROSWELL, GA 30076-3831
(770) 731-9737
Mailing address
105 ROSEMONT CT, ROSWELL, GA 30076-3831
(770) 731-9737
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
050609843
GA
Other
Enumeration date
09/20/2023
Last updated
09/20/2023
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