Provider Demographics
NPI:1629126677
Name:CRUSOR, JULIE M (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:CRUSOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 DAWSON BLVD
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-1225
Mailing Address - Country:US
Mailing Address - Phone:770-901-9303
Mailing Address - Fax:770-901-9332
Practice Address - Street 1:6010 DAWSON BLVD
Practice Address - Street 2:SUITE A-2
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1225
Practice Address - Country:US
Practice Address - Phone:770-901-9303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA55170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A551700Medicaid
G71615Medicare UPIN