Provider Demographics
NPI:1871938746
Name:CRAWFORD, MATTHEW SHANE (PA-C)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:SHANE
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5356 REYNOLDS ST
Mailing Address - Street 2:STE 505
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6016
Mailing Address - Country:US
Mailing Address - Phone:912-356-1515
Mailing Address - Fax:912-644-0756
Practice Address - Street 1:5356 REYNOLDS ST
Practice Address - Street 2:STE 505
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6016
Practice Address - Country:US
Practice Address - Phone:912-356-1515
Practice Address - Fax:912-644-0756
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006776363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I970082Medicare PIN