MEDICARE: CLARENCE LYN CROOMS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	011312	GA

General Provider Information

NPI Number	:	1205839925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARENCE LYN CROOMS M.D.

Provider Business Mailing Address
First Line	:	300 TOWER RD NE
Second Line	:	STE 200
City	:	MARIETTA
State	:	GA
Zip	:	30060-9403
Country	:	US
Telephone Number	:	770-427-5717
Fax Number	:	770-429-6503

Provider Business Practice Location Address
First Line	:	3823 ROSWELL RD
Second Line	:	SUITE 202
City	:	MARIETTA
State	:	GA
Zip	:	30062-6278
Country	:	US
Telephone Number	:	770-579-8558
Fax Number	:	770-973-1934

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	12/05/2013

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