Healthcare Provider Details

I. General information

NPI: 1811956220
Provider Name (Legal Business Name): JEFFREY WILLIAM CRONK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 W 10TH ST NE
ROME GA
30165-2638
US

IV. Provider business mailing address

PO BOX 12938 C/O CLINIC MANAGEMENT
CALHOUN GA
30703
US

V. Phone/Fax

Practice location:
  • Phone: 706-368-8530
  • Fax: 706-528-6405
Mailing address:
  • Phone: 706-602-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number27390
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number111171
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: