Provider Demographics
NPI:1649228594
Name:GROSS, DARRYL S (MD)
Entity type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:S
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3720 HOLCOMB BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4795
Mailing Address - Country:US
Mailing Address - Phone:770-263-1000
Mailing Address - Fax:770-263-7770
Practice Address - Street 1:3720 HOLCOMB BRIDGE RD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-4795
Practice Address - Country:US
Practice Address - Phone:770-263-1000
Practice Address - Fax:770-263-7770
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA025925207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD45503Medicare UPIN
GA01BDFKCMedicare ID - Type Unspecified