Healthcare Provider Details

I. General information

NPI: 1013991595
Provider Name (Legal Business Name): CRABAPPLE INTERNAL MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 W CROSSVILLE RD SUITE 501
ROSWELL GA
30075-2964
US

IV. Provider business mailing address

45 W CROSSVILLE RD SUITE 501
ROSWELL GA
30075-2964
US

V. Phone/Fax

Practice location:
  • Phone: 770-594-1233
  • Fax: 770-594-0037
Mailing address:
  • Phone: 770-594-1233
  • Fax: 770-594-0037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number43135
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number023230
License Number StateGA

VIII. Authorized Official

Name: MRS. FORREST ANN SMITH
Title or Position: PRESIDENT
Credential: MD
Phone: 770-594-1233