Provider Demographics
NPI:1366658692
Name:RANDY B CRONIC, M.D. PC
Entity Type:Organization
Organization Name:RANDY B CRONIC, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:BYRON
Authorized Official - Last Name:CRONIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-417-1780
Mailing Address - Street 1:3660 HOWELL FERRY RD
Mailing Address - Street 2:BUILDING B
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3178
Mailing Address - Country:US
Mailing Address - Phone:678-417-1780
Mailing Address - Fax:678-417-8825
Practice Address - Street 1:3660 HOWELL FERRY RD
Practice Address - Street 2:BUILDING B
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3178
Practice Address - Country:US
Practice Address - Phone:678-417-1780
Practice Address - Fax:678-417-8825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF53350Medicare UPIN
GAGRP6774Medicare ID - Type Unspecified