Provider Demographics
NPI:1437158573
Name:CRABB, MARK W (PA-C)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:W
Last Name:CRABB
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1061 HARMON AVE
Mailing Address - Street 2:STE 1D03
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5674
Mailing Address - Country:US
Mailing Address - Phone:912-435-5101
Mailing Address - Fax:912-435-5009
Practice Address - Street 1:1061 HARMON AVE
Practice Address - Street 2:STE 1D03
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5674
Practice Address - Country:US
Practice Address - Phone:912-435-5101
Practice Address - Fax:912-435-5009
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2010-11-02
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Provider Licenses
StateLicense IDTaxonomies
GA02778363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant