Healthcare Provider Details

I. General information

NPI: 1801303037
Provider Name (Legal Business Name): CRABAPPLE MEDICAL CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 05/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 RUCKER RD STE 140
ALPHARETTA GA
30004-5826
US

IV. Provider business mailing address

282 RUCKER RD STE 140
ALPHARETTA GA
30004-5826
US

V. Phone/Fax

Practice location:
  • Phone: 770-335-3340
  • Fax:
Mailing address:
  • Phone: 770-335-3340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number068936
License Number StateGA

VIII. Authorized Official

Name: ZUBAIR SADIK
Title or Position: CFO
Credential:
Phone: 770-335-3340