Healthcare Provider Details

I. General information

NPI: 1184770620
Provider Name (Legal Business Name): ALEXANDER GEBHARDT DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 E CROSSVILLE RD SUITE B
ROSWELL GA
30075-3037
US

IV. Provider business mailing address

415 E CROSSVILLE RD SUITE B
ROSWELL GA
30075-3037
US

V. Phone/Fax

Practice location:
  • Phone: 770-645-9595
  • Fax: 770-645-9522
Mailing address:
  • Phone: 770-645-9595
  • Fax: 770-645-9522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCHIRO007542
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: