NPI age
14 years
Enumerated 2011-07-08
● Active
Type 1 · Individual
Keirsun Crockett, MD
Crockett is 1 of 103 radiology providers in Marietta and 1 of 1280 in Georgia.
Primary specialty
Radiology
Plus 2 subspecialties
Licensed in
GA, VA
2 states
Status
Active
No deactivations on record
Last NPPES update
2024-02-21
Source: monthly bulk 2026-05
Sole proprietor
No
May be part of a larger org
How this provider compares
Across 1280 active radiology providers in Georgia.
NPI age
14 years
↓ 5 yr below median (19 yr)
State licenses
2 states
Top 78% — 21% of peers are multi-state
Subspecialties
2
In the 38% of peers with subspecialties
NPI lifetime · 2011 → 2026
2011-07Enumerated in NPPES
2011
2026
Where they practice
Practice location
790 Church St Ne
Marietta, GA 300607282
Mailing address
Po Box 3157
Indianapolis, IN 462063157
Additional practice locations
1 secondary location on file with NPPES.
Location 2
12200 Warwick Blvd, Suite 490a
Newport News, VA 236012344
Specialties
-
Radiology PrimaryA radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
-
RadiologyA 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.
-
Student in an Organized Health Care Education/Training ProgramAn 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.
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 (VA) | 0116023629 | VIRGINIA BOARD OF MEDICINE |
Multi-state credentialing: Licensed in 2 states. Useful context for credentialers building cross-state provider networks.
Practice context
Part of a multi-provider practice. 90 other active providers share this practice address in NPPES.
Recently enumerated nearby: 3 new radiology providers have been added in Marietta in the last 180 days.
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Request a quote →How to verify this provider
- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Check the state license is currently active.State licensing boards publish current status; NPPES does not.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.