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Individual

DR. MARK P CRUZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3950 AUSTELL RD, AUSTELL, GA 30106-1121
(770) 732-4000
Mailing address
5665 NEW NORTHSIDE DR NW, SUITE 320, ATLANTA, GA 30328-5831
(770) 874-5400
(770) 874-5469

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
047969
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00855313F
GA
05
00855313G
GA
05
00855313H
GA
05
00855313J
GA
01
350077800
DOL
GA
Enumeration date
08/18/2006
Last updated
11/03/2008
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