Individual
CRYSTAL WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3818 NORTHLAKE CREEK DR, TUCKER, GA 30084-3418
(404) 988-8811
Mailing address
3818 NORTHLAKE CREEK DR, TUCKER, GA 30084-3418
(404) 988-8811
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
044-R-2070
GA
Other
Enumeration date
11/29/2019
Last updated
11/29/2019
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