Crockett, Keirsun

Crockett, Keirsun is an individual health care provider with primary practice located at 790 Church St Ne , Marietta GA 30060-7282. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Neuroradiology, Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Diagnostic Radiology. Allopathic & Osteopathic Physicians / Diagnostic Radiology is his primary health care specialty. Crockett, Keirsun can be contacted via phone (678) 239-0420.

Contact Information

Primary practice address
790 Church St Ne Marietta GA 30060-7282
Phone: (678) 239-0420
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neuroradiology 2085N0700X 077719 Georgia
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X 0116023629 Virginia
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 077719 Georgia

Profile Details

NPI number 1750678967
LBN Legal business name Crockett, Keirsun
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 8th, 2011
Last updated Feb 21st, 2024 - about 9 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750678967 NPPES
Virginia Other 0116023629 VIRGINIA BOARD OF MEDICINE

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