Provider Demographics
NPI:1447937909
Name:MCCRAE, ERICA BREANN
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:BREANN
Last Name:MCCRAE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 PAVILION CT STE A
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-6666
Mailing Address - Country:US
Mailing Address - Phone:678-304-6481
Mailing Address - Fax:
Practice Address - Street 1:808 PAVILION CT STE A
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6666
Practice Address - Country:US
Practice Address - Phone:678-304-6481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHCP011550374U00000X, 376K00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide