Basic Information
| Provider Information | |||||||||
| NPI: | 1487097028 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRONIN | ||||||||
| FirstName: | JULIUS | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6311 GARNERS FERRY RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292091445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032163300 | ||||||||
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| Practice Location | |||||||||
| Address1: | UNIVERSITY OF TENNESSEE 910 MADISON AVE | ||||||||
| Address2: | SUITE 1031 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381630001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014485814 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2013 | ||||||||
| LastUpdateDate: | 10/08/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 54656 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1487097028 | 05 | MO | MEDICAID | Q024134 | 05 | TN | MEDICAID |