Healthcare Provider Details

I. General information

NPI: 1750856282
Provider Name (Legal Business Name): CAITLIN PYE CROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1348 WALTON WAY STE 5100
AUGUSTA GA
30901-5108
US

IV. Provider business mailing address

2619 DOZIER RD
APPLING GA
30802-1802
US

V. Phone/Fax

Practice location:
  • Phone: 706-724-8611
  • Fax:
Mailing address:
  • Phone: 706-832-1977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAG10180032
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: