Healthcare Provider Details

I. General information

NPI: 1457551046
Provider Name (Legal Business Name): NORCROSS MC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 BUFORD HWY #509
NORCROSS GA
30071-3957
US

IV. Provider business mailing address

5555 BUFORD HWY #509
NORCROSS GA
30071-3957
US

V. Phone/Fax

Practice location:
  • Phone: 404-551-7226
  • Fax:
Mailing address:
  • Phone: 404-551-7226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSE CARLOS RIOS BETANCOURT
Title or Position: OWNER
Credential:
Phone: 404-551-7226