Basic Information
| Provider Information | |||||||||
| NPI: | 1972151330 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROMARTIE | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | VINCENT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | PT, DPT, CSCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1220 ETHANS WAY | ||||||||
| Address2: | |||||||||
| City: | MCDONOUGH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302528575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786513308 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3580 ATLANTA AVE | ||||||||
| Address2: | |||||||||
| City: | HAPEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303541706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047683351 | ||||||||
| FaxNumber: | 4047632002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2019 | ||||||||
| LastUpdateDate: | 08/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT014319 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.