Provider Demographics
NPI:1871211797
Name:CRUTCHFIELD, BONNIE SHIRRELL (RN)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:SHIRRELL
Last Name:CRUTCHFIELD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 PEACHTREE BLVD
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-4007
Mailing Address - Country:US
Mailing Address - Phone:770-851-7467
Mailing Address - Fax:
Practice Address - Street 1:206 PEACHTREE BLVD
Practice Address - Street 2:
Practice Address - City:BONAIRE
Practice Address - State:GA
Practice Address - Zip Code:31005-4007
Practice Address - Country:US
Practice Address - Phone:770-851-7467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)