Provider Demographics
NPI:1740363423
Name:CROSS, EDWARD REX III (BS)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:REX
Last Name:CROSS
Suffix:III
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-767-3600
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:109 W WATAUGA AVE
Practice Address - Street 2:WATAUGA C & Y
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-5621
Practice Address - Country:US
Practice Address - Phone:423-232-2700
Practice Address - Fax:423-232-2789
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator