Provider Demographics
NPI:1457317919
Name:KRUER, JAMES A JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:KRUER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-0023
Mailing Address - Fax:770-219-0694
Practice Address - Street 1:1315 JESSE JEWELL PARKWAY NE
Practice Address - Street 2:NGPG MEDICAL PARK 1, SUITE 110
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:770-219-0023
Practice Address - Fax:770-219-0694
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060183207R00000X, 208000000X
GA079266207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4194074Medicaid
GA079266Medicaid
G49697Medicare UPIN
GA079266Medicaid