Provider Demographics
NPI:1609801018
Name:CROOKER, CHRISTOPHER SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:SCOTT
Last Name:CROOKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:748 OLD NORCROSS RD
Mailing Address - Street 2:SUITE 185
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-3393
Mailing Address - Country:US
Mailing Address - Phone:770-277-8554
Mailing Address - Fax:770-277-1799
Practice Address - Street 1:748 OLD NORCROSS RD
Practice Address - Street 2:SUITE 185
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-3393
Practice Address - Country:US
Practice Address - Phone:770-277-8554
Practice Address - Fax:770-277-1799
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039315207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00756104BMedicaid
GA970027535OtherMEDICARE RR
GAG34181Medicare UPIN
GA00756104BMedicaid