Provider Information for 1184767790
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Mr. KEN SHARROD CRUMPTON MA, MFT
Sex: Male
NPI: 1184767790
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1184767790 | ||||||||||||||||
| Enumeration Date | 2007-02-14 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 105 ASHTONBROOK DR MCDONOUGH, GA 30252-6704 United States Phone: 770-377-7553 | Fax: | ||||||||||||||||
| Primary Practice Address | 595 OLD NORCROSS RD BLDG. B LAWRENCEVILLE, GA 30045-3327 United States Phone: 770-995-6901 | Fax: | ||||||||||||||||
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