Healthcare Provider Details

I. General information

NPI: 1093004616
Provider Name (Legal Business Name): CRAIG RODNEY MCCREADY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 HOSPITAL BLVD STE 230
ROSWELL GA
30076-0001
US

IV. Provider business mailing address

4500 HOSPITAL BLVD STE 230
ROSWELL GA
30076-0001
US

V. Phone/Fax

Practice location:
  • Phone: 470-956-4560
  • Fax: 770-475-8968
Mailing address:
  • Phone: 470-956-4560
  • Fax: 770-475-8968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number82984
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: