MEDICARE: DR. ALEXANDER S GROSS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	030078	GA
2	207NS0135X	Procedural Dermatology Physician	030078	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GRP6141	OTHER	GA	MEDICARE ID-TYPE UNSPECIFIED
3	070015702	OTHER	GA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306826490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER S GROSS M.D.

Provider Business Mailing Address
First Line	:	3379 PEACHTREE RD NE
Second Line	:	STE 500
City	:	ATLANTA
State	:	GA
Zip	:	30326-1418
Country	:	US
Telephone Number	:	770-781-5077
Fax Number	:	770-781-3915

Provider Business Practice Location Address
First Line	:	1505 NORTHSIDE BLVD
Second Line	:	SUITE 1500
City	:	CUMMING
State	:	GA
Zip	:	30041-7623
Country	:	US
Telephone Number	:	770-781-5077
Fax Number	:	770-781-3915

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	06/17/2022

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Directions to “ DR. ALEXANDER S GROSS M.D.” Practice Location

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