Provider Demographics
NPI:1144682303
Name:SWEET APPLE MEDICAL GROUP
Entity type:Organization
Organization Name:SWEET APPLE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:K
Authorized Official - Last Name:GEBHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-241-2050
Mailing Address - Street 1:11040 CRABAPPLE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2457
Mailing Address - Country:US
Mailing Address - Phone:770-565-5510
Mailing Address - Fax:
Practice Address - Street 1:11040 CRABAPPLE RD
Practice Address - Street 2:SUITE C
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2457
Practice Address - Country:US
Practice Address - Phone:770-565-5510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007542111N00000X
GA44023208D00000X
GA020987208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty