Healthcare Provider Details

I. General information

NPI: 1063438679
Provider Name (Legal Business Name): RANDY BYRON CRONIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 06/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 HOWELL FERRY RD BLDG B
DULUTH GA
30096
US

IV. Provider business mailing address

PO BOX 1865
DULUTH GA
30096
US

V. Phone/Fax

Practice location:
  • Phone: 770-670-4640
  • Fax: 770-670-4644
Mailing address:
  • Phone: 770-670-4640
  • Fax: 770-670-4644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number038721
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: