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General NPI Number Information
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NPI Number | 1386837896
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Entity Type | Individual
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Provider Name | JERRY STEPHEN KROLL M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 08/07/2012
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Provider Practice Location Address
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Address Line | 5445 MERIDIAN MARKS RD NE SUITE 250
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City | ATLANTA
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State | GA
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Zip | 30342-4763
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Country | US
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Telephone | 404-255-1933
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Fax | 404-256-7924
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Provider Business Mailing Address
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Address Line | 5445 MERIDIAN MARKS RD NE STE 250
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City | ATLANTA
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State | GA
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Zip | 30342-4767
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Country | US
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Telephone | 404-255-1933
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Fax | 404-256-7924
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080S0010X
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Taxonomy Name | Pediatric Sports Medicine Physician
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License Number | 062735
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License Number State | GA
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