Provider Demographics
NPI:1568879583
Name:EAST ATLANTA INTERNAL MEDICINE
Entity Type:Organization
Organization Name:EAST ATLANTA INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRONAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-784-1569
Mailing Address - Street 1:10155 EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-3805
Mailing Address - Country:US
Mailing Address - Phone:770-784-1569
Mailing Address - Fax:770-787-8557
Practice Address - Street 1:10155 EAGLE DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-3805
Practice Address - Country:US
Practice Address - Phone:770-784-1569
Practice Address - Fax:770-787-8557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty