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NPI Code Detail

MEDICARE: JOSEPH W REDCROSS II D.O.

MEDICARE: JOSEPH W REDCROSS II D.O.
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
1208600000XSurgery Physician1132SC
2208600000XSurgery PhysicianOT 010413PA
3208600000XSurgery Physician69941GA
4202K00000XPhlebology Physician1132SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912107640
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPH W REDCROSS II D.O.
Provider Business Mailing Address
First Line : 55 WHITCHER ST NE STE 130
Second Line :
City : MARIETTA
State : GA
Zip : 30060-1156
Country : US
Telephone Number : 770-428-0462
Fax Number :
Provider Business Practice Location Address
First Line : 55 WHITCHER ST NE STE 130
Second Line :
City : MARIETTA
State : GA
Zip : 30060-1156
Country : US
Telephone Number : 770-428-0462
Fax Number : 770-427-8001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2007
Last Update Date : 11/08/2019

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