Provider Demographics
NPI:1417939182
Name:CROMER, MARCUS (MD)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:
Last Name:CROMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 OGLETHORPE AVE STE 3300
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2190
Mailing Address - Country:US
Mailing Address - Phone:706-208-1406
Mailing Address - Fax:706-208-1407
Practice Address - Street 1:1500 OGLETHORPE AVE STE 3300
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2190
Practice Address - Country:US
Practice Address - Phone:800-532-6151
Practice Address - Fax:706-354-5769
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAP54480207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA063483775AMedicaid
GAP00173058OtherRAILROAD MEDICARE
GA93BBGXBMedicare ID - Type Unspecified