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Keirsun Crockett, MD
Diagnostic Radiology Physician in Marietta, Georgia
NPI 1750678967

Keirsun Crockett is a Diagnostic Radiology Physician based in Indianapolis, GA and is specialized in Diagnostic Radiology. Keirsun Crockett practices in Marietta, GA and has the professional credentials of MD. The NPI Number for Keirsun Crockett is 1750678967 and holds a License No. 077719 (Georgia).

The current practice location address for Keirsun Crockett is 790 Church St Ne, Marietta, GA and can be reached out via phone at 678-239-0420. You can also correspond with Keirsun Crockett through the mailing address at PO BOX 3157, INDIANAPOLIS, IN - 46206-3157 (mailing address contact number: 770-405-2976).

Location: 790 Church St Ne, Marietta, GA, 46206-3157
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1750678967
Provider Name
Keirsun Crockett
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
790 Church St Ne, Marietta, GA, 46206-3157
Phone Number
678-239-0420
Fax Number
Provider Enumeration Date
07/08/2011
Last Update Date
03/12/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
0116023629 01 VA VIRGINIA BOARD OF MEDICINE
institution
Provider Business Practice Location Address Details
Address
790 Church St Ne
City
Marietta
State
Georgia
Zip
30060-7282
Phone Number
678-239-0420
Fax Number
person
Provider Business Mailing Address Details
Address
790 Church St Ne
City
Marietta
State
Georgia
Zip
30060-7282
Phone Number
678-239-0420
Fax Number
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Radiology
Speciality
Neuroradiology
Taxonomy
2085N0700X
License No.
077719 (Georgia)
Definition
A radiologist who diagnoses and treats diseases utilizing imaging procedures as they relate to the brain, spine and spinal cord, head, neck and organs of special sense in adults and children.
person
Provider's Taxonomy Details 2
Type
Allopathic & Osteopathic Physicians
Classification
Radiology
Speciality
Diagnostic Radiology
Taxonomy
2085R0202X
License No.
0116023629 (Virginia)
Definition
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
person
Provider's Taxonomy Details 3
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
077719 (Georgia)
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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