Provider Demographics
NPI:1558149799
Name:CROSS, DEVON DEON (NP)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:DEON
Last Name:CROSS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5394 BROOKLANDS DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-2106
Mailing Address - Country:US
Mailing Address - Phone:256-655-3599
Mailing Address - Fax:
Practice Address - Street 1:759 JOSEPH E BOONE BLVD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30314-3800
Practice Address - Country:US
Practice Address - Phone:404-817-9994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2023001414363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily