MEDICARE: DR. MICHAEL PHILLIP GROSS MD

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	208200000X	Plastic Surgery Physician	87241	GA

General Provider Information

NPI Number	:	1366403487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL PHILLIP GROSS MD

Provider Business Mailing Address
First Line	:	10280 GROOMSBRIDGE RD
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30022-7315
Country	:	US
Telephone Number	:	239-849-4189
Fax Number	:

Provider Business Practice Location Address
First Line	:	6491 PEACHTREE INDUSTRIAL BLVD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30360-2100
Country	:	US
Telephone Number	:	239-849-4189
Fax Number	:

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	10/30/2023

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