Individual
MR. JOSEPH GRATTON CROCKETT III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
6724 MORGAN CT, YOUNG HARRIS, GA 30582-2551
(706) 379-4068
(706) 379-0640
Mailing address
PO BOX 238, 1200 WESTBROOK ROAD COMMERCE, GA 30530, YOUNG HARRIS, GA 30582-0238
(706) 379-4068
(706) 379-0640
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
6316
NC
225XP0200X
Pediatric Occupational Therapist
Primary
OT000783
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00969647A
—
GA
Enumeration date
02/15/2007
Last updated
07/09/2007
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