Provider Demographics
NPI:1992779490
Name:CROSS, JOE ALLEN (DPH)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:ALLEN
Last Name:CROSS
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4129
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-4129
Mailing Address - Country:US
Mailing Address - Phone:423-569-9186
Mailing Address - Fax:
Practice Address - Street 1:20029 ALBERTA ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-3501
Practice Address - Country:US
Practice Address - Phone:423-569-8652
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6697183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist