Provider Demographics
NPI:1831396225
Name:CROSS, BRANDY NOELLE (MD)
Entity type:Individual
Prefix:DR
First Name:BRANDY
Middle Name:NOELLE
Last Name:CROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3747 ROSWELL RD.
Mailing Address - Street 2:STE 312
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6215
Mailing Address - Country:US
Mailing Address - Phone:470-956-7547
Mailing Address - Fax:
Practice Address - Street 1:3747 ROSWELL RD STE 312
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6227
Practice Address - Country:US
Practice Address - Phone:470-956-7547
Practice Address - Fax:678-560-5727
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA18313962252086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1831396225Medicaid
SCNC2087Medicaid
SCNC2087Medicaid
NCNCH965AMedicare PIN