Provider Demographics
NPI:1871688317
Name:CRONAN, JAMES CLINTON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CLINTON
Last Name:CRONAN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3400 MCCLURE BRIDGE RD
Mailing Address - Street 2:BUILDING B201
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-6675
Mailing Address - Country:US
Mailing Address - Phone:678-957-8801
Mailing Address - Fax:678-957-8804
Practice Address - Street 1:3400 MCCLURE BRIDGE RD
Practice Address - Street 2:BUILDING B201
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-6675
Practice Address - Country:US
Practice Address - Phone:678-957-8801
Practice Address - Fax:678-957-8804
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA28757208200000X
CAG86208208200000X
GA028757208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1871688317OtherBCBS
NE470376583-24Medicaid
GA308535506AMedicaid
GAN534531OtherWELLCARE
D91010Medicare UPIN
090190Medicare PIN
GA511I240013Medicare UPIN