Individual
LAWRENCE O CROCKETT SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AUD
Contact information
Practice address
150 NACOOCHEE AVE, ATHENS, GA 30601-1823
(706) 546-5689
(706) 543-7675
Mailing address
150 NACOOCHEE AVE, ATHENS, GA 30601-1823
(706) 546-5689
(706) 543-7675
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
AUD003507
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000848273B
—
GA
01
—
581585042
ATHENS AREA HEALTH PLAN S
GA
01
—
584585042
UNITED HEALTH CARE
GA
Enumeration date
04/25/2006
Last updated
01/27/2009
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