Basic Information
| Provider Information | |||||||||
| NPI: | 1366622250 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEDWITH | ||||||||
| FirstName: | CRYSTAL | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | WHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 MEDICAL CENTER BLVD | ||||||||
| Address2: | SUITE 290 | ||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300458708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709625100 | ||||||||
| FaxNumber: | 7709622400 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 MEDICAL CENTER BLVD | ||||||||
| Address2: | SUITE 290 | ||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300458708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709625100 | ||||||||
| FaxNumber: | 7709622400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2007 | ||||||||
| LastUpdateDate: | 11/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | RN159890 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.