Individual provider Active NPI

Joseph W Redcross II, D.O.

  • Surgery Physician
  • Marietta, GA
National Provider Identifier
1912107640
Registry record updated Nov 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
69941 Issued in GA
Practice address
55 Whitcher St NE Ste 130
Marietta, GA 30060-1156
Phone
(770) 428-0462
Fax
(770) 427-8001
NPI assigned
Jul 20, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 1132 SC
Surgery Physician 208600000X OT 010413 PA
Surgery Physician 208600000X 69941 GA Primary
Phlebology Physician 202K00000X 1132 SC

Addresses

Primary practice location

55 Whitcher St NE Ste 130
Marietta, GA 30060-1156

Mailing address

55 Whitcher St NE Ste 130
Marietta, GA 30060-1156
Phone (770) 428-0462

Other identifiers 1

IdentifierTypeStateIssuer
GP3518MedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jredcross55659@directwellstar.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130828000295 GA Practitioner - General Surgery 5890874937 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
69941GAMDSurgery Physician
OT 010413PAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC Current Accepting new patients
The Southeast Permanente Medical Group Surgery CurrentSince Jan 27, 2024 Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients

Locations

3495 Piedmont Rd NE
Bldg 9
Atlanta, GA 30305
Phone (404) 364-7000

2701 N Decatur Rd
Decatur, GA 30033
Phone (404) 501-1000

2400 Mount Zion Pkwy
Jonesboro, GA 30236
Phone (770) 603-3649

5150 Stilesboro Rd NW
Ste 120
Kennesaw, GA 30152
Phone (678) 354-0230

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

55 Whitcher St NE
Ste 130
Marietta, GA 30060
Phone (770) 426-1629

1125 Town Center Village Dr
McDonough, GA 30253
Phone (678) 583-6557

20 Glenlake Pkwy
Sandy Springs, GA 30328
Phone (770) 677-6247

5665 Ptree Dunwoody Rd NE
Sandy Springs, GA 30342
Phone (678) 843-7001

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573171200000",
    "number": "1912107640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 WHITCHER ST NE STE 130",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601156",
            "telephone_number": "770-428-0462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 WHITCHER ST NE STE 130",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601156",
            "telephone_number": "770-428-0462",
            "fax_number": "770-427-8001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDCROSS",
        "first_name": "JOSEPH",
        "middle_name": "W",
        "name_suffix": "II",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-20",
        "last_updated": "2019-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "SC",
            "license": "1132",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "OT 010413",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "69941",
            "primary": true
        },
        {
            "code": "202K00000X",
            "taxonomy_group": "",
            "desc": "Phlebology",
            "state": "SC",
            "license": "1132",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP3518",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jredcross55659@directwellstar.org",
            "affiliation": "N",
            "address_1": "55 Whitcher St NE Ste 130",
            "city": "Marietta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300601156",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.