Provider Demographics
NPI:1831134881
Name:CROSS, JULAINE B (MD)
Entity Type:Individual
Prefix:
First Name:JULAINE
Middle Name:B
Last Name:CROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:420 E 2ND AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3210
Mailing Address - Country:US
Mailing Address - Phone:706-509-3000
Mailing Address - Fax:
Practice Address - Street 1:1025 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CEDARTOWN
Practice Address - State:GA
Practice Address - Zip Code:30125-2036
Practice Address - Country:US
Practice Address - Phone:770-748-5212
Practice Address - Fax:770-748-2944
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.42959207Q00000X
GA056037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA735066849AMedicaid
GA08BBSFRMedicare PIN
GAI38472Medicare UPIN