MEDICARE: DR. BRIAN CROSS 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	207R00000X	Internal Medicine Physician	043190	GA

General Provider Information

NPI Number	:	1720082613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN CROSS M.D.

Provider Business Mailing Address
First Line	:	2200 PEACHTREE RD NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1110
Country	:	US
Telephone Number	:	404-778-0118
Fax Number	:	404-351-7762

Provider Business Practice Location Address
First Line	:	619 S 8TH ST STE 200
Second Line	:
City	:	GRIFFIN
State	:	GA
Zip	:	30224-4260
Country	:	US
Telephone Number	:	770-227-1587
Fax Number	:	770-227-1485

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	11/18/2024

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