Healthcare Provider Details

I. General information

NPI: 1528585486
Provider Name (Legal Business Name): CROSSROADS TREATMENT CENTER OF SANDY SPRINGS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 08/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 CARPENTER DR STE 101
ATLANTA GA
30328-4909
US

IV. Provider business mailing address

55 BEATTIE PL STE 810
GREENVILLE SC
29601-2191
US

V. Phone/Fax

Practice location:
  • Phone: 470-312-2933
  • Fax: 470-819-4175
Mailing address:
  • Phone: 864-527-3145
  • Fax: 864-990-0653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: DR. RUPERT MCCORMAC
Title or Position: PRESIDENT
Credential: MD
Phone: 864-527-3145