Provider Demographics
NPI:1770659385
Name:CROSS CREEK ENTERPRISE, INC.
Entity Type:Organization
Organization Name:CROSS CREEK ENTERPRISE, INC.
Other - Org Name:FOOT SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:770-914-9323
Mailing Address - Street 1:1778 JONESBORO RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-5900
Mailing Address - Country:US
Mailing Address - Phone:770-914-9323
Mailing Address - Fax:770-914-9324
Practice Address - Street 1:1778 JONESBORO RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-5900
Practice Address - Country:US
Practice Address - Phone:770-914-9323
Practice Address - Fax:770-914-9324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2286352-LB335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5816610001Medicare NSC