Provider Demographics
NPI:1922028349
Name:GROSS, ROBERT E (MD, PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 CLIFTON RD NE
Mailing Address - Street 2:SUITE B6200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:404-727-2354
Mailing Address - Fax:404-778-4472
Practice Address - Street 1:1365 CLIFTON RD NE
Practice Address - Street 2:SUITE B6200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-727-2354
Practice Address - Fax:404-778-4472
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA50173207T00000X
NY188904207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G07130Medicare UPIN