MEDICARE: CROSSROADS TREATMENT CENTER OF SANDY SPRINGS, PC

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	251S00000X	Community/Behavioral Health Agency
2	261QM2800X	Methadone Clinic

General Provider Information

NPI Number	:	1528585486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSROADS TREATMENT CENTER OF SANDY SPRINGS, PC

Provider Business Mailing Address
First Line	:	55 BEATTIE PL STE 810
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2191
Country	:	US
Telephone Number	:	864-527-3145
Fax Number	:	864-990-0653

Provider Business Practice Location Address
First Line	:	275 CARPENTER DR STE 101
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-4909
Country	:	US
Telephone Number	:	470-312-2933
Fax Number	:	470-819-4175

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RUPERT MCCORMAC
Credential	:	MD
Telephone Number	:	864-527-3145

Provider Enumeration Date	:	08/23/2017
Last Update Date	:	08/23/2017

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